Awareness is due to negligence during general anaesthesia for caesarean section

Abstract

Every anaesthetist has a duty of care to his patient. Duty of care is a legal concept, which encompasses the anaesthetist’s obligation to: (i) attend to patients; (ii) warn of likely hazards; (iii) apply such technical procedures as are appropriate; and (iv) tell the patient what happened if untoward events occur. The anaesthetist should be capable of delivering safe, effective anaesthesia. In order to achieve this anaesthetic equipment must be fully functional and properly maintained, with particular attention paid to any items which have just returned from service or repair. The monitoring equipment must be appropriate. Wherever possible, the techniques used should lie within the limits of currently accepted practice, and the patient, at all times, should receive undivided attention. An adequate written record must be kept of the anaesthetic procedure and physiological monitoring data. A poor record may invoke suspicions that clinical care may have been just as poor. Indeed, a claim may be impossible to defend unless the anaesthetist can produce a contemporaneous record showing what agents were used and in what concentrations or doses they were administered. If by error or omission the anaesthetist fails to do these things, he fails to discharge this duty of care and may be judged to be negligent. Accidental awareness during surgery is, in the majority of cases, the result of inadequate anaesthesia caused by human error on the part of the anaesthetist. The causes are legion, and include failure to: (i) check a faulty anaesthetic machine; (ii) fill a vaporizer; and (iii) set the flow-meters or vaporizer controls correctly. Even worse, there have been cases where the anaesthetist administered a grossly inadequate anaesthetic because of an erroneous concept of what concentrations of gases and vapours were required to maintain insensibility.