Abstract
Anaesthesia represents a high insurance risk for the medical profession primarily for two reasons. Anaesthetists manipulate the physiology of the cardiovascular and respiratory systems and administer potentially lethal drugs which are not primarily therapeutic; consequently, when a serious accident occurs, it may result in hypoxaemia or ischaemia within seconds or minutes, culminating in death or permanent neurological damage. In addition, because the majority of patients are healthy, even minor morbidity attributed to anaesthesia or the anaesthetist may be regarded as unacceptable to the patient, even though more serious forms of morbidity which are perceived as an inevitable complication of surgery may be tolerated without complaint.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Ackers v Wigan Health Authority (1986), referred to in Current Law, March 1986..
Adams AP (1975) Techniques of vascular control for deliberate hypotension during anaesthesia. Br J Anaesth 47: 777–792.
Adams AP, Baird WLM, Sykes MK et al. (1988) Recommendations for standards of monitoring during anaesthesia and recovery. Association of Anaesthetists of Great Britain and Ireland, London.
Adams AP, Bickford-Smith PJ, Henville JD et al. (1990) Checklist for anaesthetic machines. Association of Anaesthetists of Great Britain and Ireland, London.
Aitkenhead AR (1986) Cerebral protection. Br J Hosp Med 35: 290–298.
Aitkenhead AR (1988) Regional and local anaesthetics and spinal narcotics for postoperative pain management. Curr Opin Anaesthesiol 1: 352–358.
Aitkenhead AR (1990) Awareness during anaesthesia: what should the patient be told? Anaesthesia 45: 351–352.
Alexander SC, Smith TC, Strobel G, Stephen GW, Wollman H (1968) Cerebral carbohydrate metabolism of man during respiratory and metabolic alkalosis. J Appl Physiol 24: 66–71.
Assem ESK (1990) Anaphylactic anaesthetic reactions: the value of paper radioallergosorbent tests for IgE antibodies to muscle relaxants and thiopentone. Anaesthesia 45: 1032–1038.
Baldo BA, Fisher MM (1983) Substituted ammonium ions as allergenic determinants in drug allergy. Nature 306: 262–264.
Blacher RS (1975) On awakening paralysed during surgery. JAMA 234: 67–68.
Bonsu AK, Stead AL (1983) Accidental cross-connexion of oxygen and nitrous oxide in an anaesthetic machine. Anaesthesia 38: 767–769.
Brahams D (1990) Medicine and the law. Two anaesthetists convicted of manslaughter. Lancet 336: 430–431.
Brierley JK, French JM, Cartlidge NEF (1991) A comparison of the neurological and neuropsychological sequelae in patients undergoing different types of cardiopulmonary bypass surgery. (In press).
Buck H, Devlin HB, Lunn JN (1987) The report of a confidential enquiry into perioperative deaths. Nuffield Provincial Hospitals Trust, London.
Cole AGH, Thompson JB, Fodor IM, Baker AB, Sear JW (1983) Anaesthetic machine hazard from the Selectatec block. Anaesthesia 38: 175–177.
Crawford JS (1984) Principles and practice of obstetric anaesthesia. Blackwell Scientific Publications, Oxford, p 297.
Eichhorn JH (1989) Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology 70: 572–577.
Faulkner A (1989) Incidence of fatal reactions to commonly used anaesthetic drugs. Letter from Ledger Bennett Public Relations Ltd. to Dame Jill Knight MP, October 26, 1989.
Fisher MMcD (1990) Medico-legal aspects of anaphylaxis. J Med Defence Union, Spring: 4-5.
Fisher MMcD, Baldo BA (1984) Anaphylactoid reactions during anaesthesia. Clin Anaesthesiol 2: 677–692.
Gaba DM, DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology 69: 387-394.
Garcia JH, Conger KA (1981) Ischemic brain injuries: structural and biochemical effects. In: Grenvik A, Safar P (eds) Brain failure and resuscitation. Churchill Livingstone, New York, pp 35–54 (Clinics in critical care medicine, vol 2).
Hanning CD, Kruchek D, Chunara A (1987) Preferential oxygen leak — an unusual case. Anaesthesia 42: 1329–1330.
Hargrove RL (1987) Awareness under anaesthesia. J Med Defence Union, Spring: 9-11.
Harle DG, Baldo BA, Fisher MM (1984) Detection of IgE antibodies to suxamethonium after anaphylactoid reactions during anaesthesia. Lancet ii: 930–932.
Harris TJB, Brice DD, Hetherington RR, Utting JE (1971) Dreaming associated with anaesthesia: the influence of morphine premedication and two volatile adjuvants. Br J Anaesth 43: 172–178.
Hutchinson R (1960) Awareness during surgery. Br J Anaesth 33: 463–469.
Kelbie D (1989) Sheriff D. Kelbie, Sheriffdom of Grampian, Highlands and Islands Determination given on 9 May 1989 at Aberdeen.
Kolata GB, Marx JL (1976) Epidemiology of heart diseases: searches for causes. Science 194: 509–511.
Levinson BW (1965) States of awareness during general anaesthesia. Br J Anaesth 67: 544–546.
Lindop MJ (1975) Complications and morbidity of controlled hypotension Br J Anaesth 47: 799–803.
Liu D, Thorp S, Graham S, Aitkenhead AR (1990) Incidence of recall of awareness during anaesthesia for non-obstetric surgery. Br J Anaesth 65: 575–576.
Lunn JN, Mushin WW (1982) Mortality associated with anaesthesia. Nuffield Provincial Hospitals Trust, London.
McKenna T, Wilton TNP (1973) Awareness during endotracheal intubation. Anaesthesia 28: 599–602.
Millar K (1989) Recall, recognition and implicit memory for intra-anaesthetic events. In: Jones JG (ed) Depth of anaesthesia. Baillière Tindall, London, pp 487–510 (Baillière’s clinical anaesthesiology: international practice and research, vol 3.
Moir DD (1976) Obstetric anaesthesia and analgesia. Baillière Tindall, London, p 145.
Nimmo WS, Aitkenhead AR, Clarke RSJ et al. (1990) Anaphylactic reactions associated with anaesthesia. Association of Anaesthetists of Great Britain and Ireland, London.
Noble DW, Yap PL (1989) Screening for antibodies to anaesthetics. No case for doing it yet. Br Med J 299: 2.
Notcutt WG, Morgan RJM (1990) Introducing patient-controlled analgesia for postoperative pain control into a district general hospital. Anaesthesia 45: 406–408.
Nunn JF (1987) Applied respiratory physiology, 3rd edn. Butterworth, London.
Plum F, Posner JB (1982) The diagnosis of stupor and coma, 3rd edn. FA Davis Company, Philadelphia.
Safar P (1981) Resuscitation after brain ischemia. In: Grenvik A, Safar P (eds) Brain failure and resuscitation. Churchill Livingstone, New York, pp 155–184 (Clinics in critical care medicine, vol 2).
Schwilden H (1989) Use of the median EEG frequency and pharmacokinetics in determining depth of anaesthesia. In: Jones JG (ed) Depth of anaesthesia. Baillière Tindall, London, pp 603–621 (Baillière’s clinical anaesthesiology: international practice and research, vol 3).
Sear JW (1983) General kinetic and dynamic principles and their application to continuous infusion anaesthesia. Anaesthesia 38(Suppl): 10–25.
Sebel PS (1989) Somatosensory, visual and motor evoked potentials in anaesthetized patients. In: Jones JG (ed) Depth of anaesthesia. Baillière Tindall, London, pp 587–602 (Baillière’s clinical anaesthesiology: international practice and research, vol 3).
Shaw PJ, Bates D, Cartlidge NEF et al. (1986) Neurological complications of coronary artery bypass surgery: six-month follow-up study. Br Med J 293: 165–167.
Siesjo BK, Ljunggren B (1973) Cerebral energy reserves after prolonged hypoxia and ischemia. Arch Neurol 29: 400–407.
Smith GB, Hirsch NP, Ehrenwerth J (1986) Placement of double-lumen endobronchial tubes: correlation between clinical impressions and bronchoscopic findings. Br J Anaesth 58: 1317–1320.
Stoelting RK, Longnecker DE, Eger EI (1970) Minimum alveolar concentrations in man on awakening from methoxyflurane, halothane, ether and fluroxene anesthesia: MAC awake. Anesthesiology 33: 5–9.
Thompson PW (1987) Safer design of anaesthetic equipment. Br J Anaesth 59: 913–921.
Thornton C, Konieczko K, Jones JG, Jordan C, Doré CJ, Heneghan CPH (1988) Effect of surgical stimulation on the auditory evoked response. Br J Anaesth 56: 372–378.
Thorp JM, Railton R (1982) Hypoxia due to air in the oxygen pipeline: a case for oxygen monitoring in theatre. Anaesthesia 37: 683–687.
Tinker JH, Dull DL, Caplan RA, Ward RJ, Cheney FW (1989) Role of monitoring devices in prevention of anesthetic mishaps: a closed claim analysis. Anesthesiology 71: 541–546.
Tunstall ME (1977) Detecting wakefulness during general anaesthesia for Caesarean section. Br Med J i: 1321.
Utting JE (1987) Pitfalls in anaesthetic practice. Br J Anaesth 59: 877–890.
Vacanti D, Van Houten RJ, Hill RC (1970) A statistical analysis of the relationship of physical status to postoperative mortality in 68386 cases. Anesth Anal 49: 564–567.
Ward CS (1985) The continuous flow anaesthetic machine. In: Ward CS, Anaesthetic equipment, 2nd edn. Baillière Tindall, London, pp 104–121.
Watkins J (1989) Second report from an anaesthetic advisory service. Anaesthesia 44: 157–159.
Whitby LG (1974) Screening for disease. Definitions and criteria. Lancet i: 819–822.
White DC (1987) Anaesthesia: a privation of the senses. An historical introduction and some definitions. In: Rosen M, Lunn JN (eds) Consciousness awareness and pain in general anaesthesia. Butterworth, London, pp 1–9.
Williams KN, Nunn JF (1989) The oesophageal detector device. A prospective trial on 100 patients. Anaesthesia 44: 412–414.
Wilson SH, Vaughan RW, Stephen CR (1975) Awareness, dreams and hallucinations associated with general anesthesia. Anesth Analg 54: 609–616.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1991 Springer-Verlag London Limited
About this chapter
Cite this chapter
Aitkenhead, A.R. (1991). Anaesthesia. In: Jackson, J.P. (eds) A Practical Guide to Medicine and the Law. Springer, London. https://doi.org/10.1007/978-1-4471-1863-3_4
Download citation
DOI: https://doi.org/10.1007/978-1-4471-1863-3_4
Publisher Name: Springer, London
Print ISBN: 978-1-4471-1865-7
Online ISBN: 978-1-4471-1863-3
eBook Packages: Springer Book Archive