A 34-year old woman with no significant past medical history was admitted for elective repair of a paraumbilical hernia. The anaesthetist reviewed her pre-operatively. She explained the anaesthetic process and advised of the risks of dental damage, sore throat, post-operative nausea, vomiting and pain.
With full monitoring, the patient was anaesthetised in the anaesthetic room using fentanyl, propofol and atracurium. The anaesthetist intubated the patient atraumatically and anaesthesia continued using a volatile anaesthetic gas. Shortly afterwards, the anaesthetist disconnected the patient from the anaesthetic machine and transferred her into theatre. The monitoring was reattached and ventilation restarted. Anaesthesia continued by means of the anaesthetic gas. The vaporiser device delivering this was placed on a low setting while the surgical team carried out the checklist and instrument checks, before starting the surgery itself.
She was able to recall her abdomen being touched by cold fluid.
The scrub nurse proceeded to prepare the abdomen with antiseptic, at which point she noticed the patient's hand move. A member of staff alerted the anaesthetist, who responded quickly by giving a further bolus of propofol and increasing the anaesthetic gas delivery. Surgery continued uneventfully.
In the recovery room, the patient was tearful and distressed. She was able to recall her abdomen being touched with a cold fluid, accompanied by a sensation of not being able to breathe properly. She remembered a voice remarking that her hand had moved. She did not remember anything else about the surgery, and certainly not anything painful.
The anaesthetist reviewed the patient in recovery and concluded that her account was consistent with the events in theatre. She apologised to the patient and gave an explanation of what had happened. Understandably, the patient remained upset.
Several weeks later, the patient brought a claim against the anaesthetist. She alleged that the anaesthetist had provided inadequate anaesthesia at the start of the procedure and as a result she suffered insomnia and flashbacks for several weeks. The MDU discussed the case with the anaesthetist, who acknowledged that the patient's account was accurate and consistent with a brief episode of awareness. In light of this, she accepted the MDU's advice that the claim would need to be settled. The MDU dealt with the patient directly and settled the claim for £3,000, with no formal admission of liability. The matter was concluded swiftly within six weeks and without the need for the patient to engage a solicitor to represent her, the costs of which are usually borne by the MDU in a claim which is settled.
Dr Thom Petty
Senior medical claims handler
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