This case involves a forty-four-year-old woman who was admitted to a hospital for a cholecystectomy. The woman had a history of smoking, and her vitals were normal, with a blood pressure of 124/82. She was properly prepped by both the surgeon and the anesthesiologist and was informed that she would be receiving Ketalar as her anesthetic. However, during intubation, the patient’s oxygen count began to slightly decline, and the anesthesiologist shifted the tube. The shift caused the patient’s oxygen’s level to decline further, and the endotracheal tube was removed approximately 45 seconds later. The operation was stopped, and the operating physician had the patient checked for any signs of injury. It was determined that the trauma from the tube damaged the thyroid cartilage, causing a loss of oxygen and had a severely negative impact on the patient’s voice. The surgery was never completed, and the patient’s quality of life decreased substantially due to the damage on the vocal cords. The patient was a secretary and was unable to return to work due to her loss of voice.
Question(s) For Expert Witness
1. Is the damage that affected the patient’s voice a deviation of the standard of care for the anesthesiologist?
Expert Witness Response
One of the main objectives for an anesthesiologist is to protect the patient’s airway. In my opinion, the standard of care was poor due to the injury during intubation. Intubation is a commonly practiced technique, and the anesthesiologist failed to notice that something was wrong during the first attempt. It is a standard technique and one of the most vital. Various tools exist to ensure proper execution in a timely manner. By shifting the tube, he caused further damage to the patient and put the patient at risk of complete lack of oxygen. Loss of oxygen can be damage many parts of the human body, with the brain being a high possibility. The patient was also at risk for neurological damage as well, which could cause an even further reduction in quality of life. The tube should have been removed sooner than 45 seconds after complications arose.
About the author
Dr. Faiza Jibril
Dr. Faiza Jibril has extensive clinical experience ranging from primary care in the United Kingdom, to pediatrics and child abuse prevention at Mount Sinai Hospital, to obstetrics in Cape Town, South Africa. Her post-graduate education centered on clinical research and medical ethics. Dr. Jibril is currently Head of Sales in the US and Canada for Chambers and Partners - a world leading legal ranking and insights intelligence company.
