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Written on 26th March 2020 by Susan Brown

Modern anaesthesia is generally regarded as both sophisticated and safe. Where serious injury occurs during or after surgery, it usually arises from factors that are not directly related to the anaesthetic. However, where serious brain injury occurs during an operation, the patient’s family should seek advice about whether there might be a claim arising from the actions of the anaesthetist...

One of the anaesthetist’s vital roles during surgery is to keep the patient properly oxygenated. This requires skill, judgement and vigilance throughout the procedure for the protection of the patient’s safety. On the rare occasions when mistakes are made which affect the patient’s oxygen supply, the resulting brain injury can be catastrophic. Where a patient dies or suffers brain injury caused by lack of oxygen during surgery, they may be entitled to compensation.

Why does a patient need to be given oxygen during a general anaesthetic?

When an operation is performed under general anaesthetic, the anaesthetist keeps the patient in a state of controlled unconsciousness using anaesthetic drugs. These drugs block the nerve signals to the brain to ensure that the patient cannot feel anything during the surgery. This state of pain-free, controlled unconsciousness is what we mean when we talk about being ‘anaesthetised’ or ‘put under’.

The patient needs to lie still for the surgeon to operate safely, so the anaesthetist keeps the patient’s body motionless by administering muscle relaxants. Once the patient has been given the muscle relaxants, they can’t move but they also can’t breathe without assistance. The anaesthetist keeps the patient oxygenated by putting an endotracheal tube into their airway (or trachea). The endotracheal tube is connected to a ventilator machine which takes over their breathing by administering a controlled flow of oxygen. The anaesthetist then monitors the patient closely during surgery to ensure that they maintain safe levels of oxygenation, as well as other signs, such as blood pressure, respiration rate, heart rate, and carbon dioxide levels. Correct monitoring means that they can react quickly if errors, complications or reactions occur.

What kind of anaesthetic mistakes lead to brain injury claims?

Serious brain injuries arising from anaesthetic accidents are rare, but compensation claims arise most commonly from one or more of the following mistakes:

Intubation errors

Intubation is the medical name for the procedure that is used by the anaesthetist to position the breathing tube in the patient’s airway. Oxygen is delivered to the patient via the endotracheal tube, so it must be positioned correctly and in a way that ensures that oxygen from the ventilator reaches the patient’s lungs. It must also be properly positioned to ensure that stomach contents are not breathed into the patient’s lungs if the patient vomits during the procedure. It is the anaesthetist’s responsibility to ensure that the tube is clear, properly positioned and connected to the ventilator. It is also their job to ensure that it does not become dislodged or blocked during surgery.

Where a patient suffers a brain injury (or dies) as a result of an intubation error, they (or their bereaved dependent family) may be entitled to substantial compensation.

Extubation errors

Just as intubation refers to putting the endotracheal tube in, extubation means taking the tube out. Claims usually arise from mistakes in the timing of extubation, as patients cannot breathe for themselves until the muscle relaxant has worn off. Anaesthetists must manage the patient’s revival and recovery from general anaesthetic carefully so that the patient can breathe safely at all times. Oxygen deprivation and brain injury will occur if they are taken off the ventilator too soon.

Monitoring mistakes and failing to react to complications

Mistakes, complications or unexpected reactions to the anaesthetic may be corrected without injury to the patient if they are noticed and swift action is taken to correct the problem. Claims arise when the anaesthetist fails to notice or react to signs that the patient’s safety is compromised, such as when the breathing tube is knocked and becomes dislodged, the ventilator is inadvertently switched off or the patient needs resuscitation.

Equipment failure

The anaesthetist is assisted in anaesthetising, oxygenating and maintaining the safety of the patient by numerous items of equipment. These include ventilators, monitors, alarms, tubes and pipes. These must be in good working order, correctly labelled or colour-coded in the case of pipes delivering oxygen and other gases. Spares and alternatives (such as bag and mask ventilation) must be readily available for back up in case faults or blockages occur, or oxygen or other anaesthetic gases run out during the operation. It is the anaesthetist’s job to check that the correct equipment is available and in good working order before surgery. The anaesthetist must continue to monitor the patient and notice and react quickly to keep the patient safe if equipment fails during the operation.

Where a patient suffers serious injury because equipment is faulty, is incorrectly used or switched off, becomes blocked or is unavailable during surgery, they may be entitled to claim substantial compensation.

Drug and gas errors

The anaesthetist uses a combination of many different drugs and gases to put the patient under and keep them safe during general anaesthesia. They must use their skill and judgment to choose the correct drugs and dosage for each individual patient, according to their particular circumstances and risk factors. Patients react in different ways to anaesthetic and not all reactions can be predicted, but where a patient has suffered severe injury as a result of a reaction to anaesthetic drugs, they may have a claim for compensation.

How Boyes Turner can help after serious injury from anaesthetic negligence

At Boyes Turner our brain injury lawyers are skilled in recovering compensation to help clients who have suffered brain injury or neurological disability from lack of oxygen during surgery and anaesthesia. Compensation can be a lifeline for families caring for someone with brain injury, relieving the financial hardship that inevitably follows serious injury and providing access to essential equipment, home adaptations, therapies, case management and nursing care.

If you are caring for a family member with brain injury or neurological disability from medical negligence and would like to find out more about making a compensation claim, contact us by email on