This visual impairment case involves a woman who underwent a minor ocular procedure that required her to be placed under general anesthesia. The surgery proceeded without incident for the better part of an hour until the woman began to regain consciousness. Upon waking the woman panicked, thrashing in her chair and causing a choroidal hemorrhage, which has since lead to a permanent loss of vision. It was alleged that the physician failed to administer the appropriate dosage of anesthesia, which allowed her to wake up in the middle of the procedure.
Question(s) For Expert Witness
- 1. Do you treat patients like the one described in this case? Have you ever had a patient awake from anesthesia during a procedure?
- 2. What measures should be taken to prevent this from occurring?
Expert Witness Response
I routinely treat patients with rhegmatogenous and complex retinal detachments. Depending on the age and anxiety of the patient, I usually perform procedures with light sedation, a local block and monitored anesthesia. I have encountered numerous patients that are not able to stay still for a retinal procedure and have had to either change to general anesthesia prior to the operating room or convert during the operation. If the patient was comfortable and understanding of the procedure, we can often avoid abrupt movements during the surgery with a few simple steps. If significant movement does occur, most retina surgeons are ready to quickly withdraw instruments in order to avoid injury. I have served as a treating physician in cases of assault and traumatic injury resulting in retinal detachments and loss of vision.
This expert graduated from medical school at New York University and completed an Ophthalmology residency and a two-year subspecialty fellowship in diseases and surgery of the retina and vitreous at the University of Kentucky. He is the Director of the Ocular Electrophysiology Service and specializes in age-related macular degeneration, diabetic retinopathy, retinal detachment, and uveitis at a major university medical center. Additionally, this expert is actively involved in clinical trials for new treatments for eye diseases. At the University, he leads a basic science research program on retinal aging and inflammation and has published his work in revered journals such as New England Journal of Medicine and Nature.