Anesthesia Malpractice
in Ohio

How anesthesia errors cause serious injuries

Anesthesia is one of the highest-risk aspects of any surgical procedure. The anesthesia provider is responsible for rendering the patient unconscious (or regionally numb), maintaining a patent airway, monitoring vital signs throughout surgery, managing fluid balance and blood pressure, and safely waking the patient afterward. An error at any point in this process can result in catastrophic injury.

Unlike surgical errors — which are often visible in the operative site — anesthesia errors are invisible. They occur in the physiological systems that sustain life: respiration, circulation, and brain oxygenation. When an anesthesia provider administers too much medication, fails to secure the airway, or doesn’t respond to a dropping oxygen saturation level, the damage happens internally and may not be apparent until the patient fails to wake up — or wakes up with permanent neurological deficits.

Anesthesia malpractice cases require expert analysis by a board-certified anesthesiologist who can evaluate the anesthesia record — a minute-by-minute log of drugs administered, vital signs recorded, ventilator settings, and events during surgery. Mike works with anesthesiology experts who specialize in reviewing these records to identify exactly where the standard of care was breached and how the injury could have been prevented.

Types of anesthesia and their specific risks

Different types of anesthesia carry different risk profiles, and the standard of care varies accordingly:

General anesthesia

General anesthesia renders the patient completely unconscious and requires endotracheal intubation or a supraglottic airway device to maintain breathing. The primary risks include: difficult intubation (failure to place the breathing tube, leading to oxygen deprivation), aspiration (stomach contents entering the lungs during intubation), anesthetic overdose (causing prolonged unconsciousness, respiratory depression, or cardiac arrest), malignant hyperthermia (a rare but potentially fatal reaction to certain anesthetic agents in genetically susceptible patients), and postoperative cognitive dysfunction. The provider must have a difficult airway plan, proper equipment (video laryngoscope, fiberoptic bronchoscope), and the ability to perform a surgical airway (cricothyrotomy) if all else fails.

Regional anesthesia (epidural and spinal)

Epidural and spinal anesthesia numb a specific region of the body and are commonly used for cesarean deliveries, hip and knee replacements, and lower abdominal surgery. Risks include: epidural hematoma (bleeding in the epidural space that can compress the spinal cord and cause paralysis if not decompressed within hours), epidural abscess (infection at the injection site), high spinal block (anesthetic spreading higher than intended, potentially reaching the brainstem and causing respiratory arrest), nerve damage from needle placement, and post-dural puncture headache (from accidental puncture of the dural membrane). The standard of care requires careful needle placement using loss-of-resistance technique, monitoring for signs of complications, and prompt treatment when they occur.

Monitored anesthesia care (MAC) and sedation

MAC involves IV sedation while the patient remains spontaneously breathing. Common for colonoscopies, dental procedures, and minor surgeries. The primary risk is over-sedation — giving too much sedative, causing the patient to stop breathing. The provider must continuously monitor oxygen saturation, end-tidal CO2 (capnography), heart rhythm, and blood pressure. Failure to use capnography monitoring during sedation — which detects respiratory depression before oxygen levels drop — is an increasingly recognized standard of care violation, particularly after the ASA (American Society of Anesthesiologists) updated its monitoring standards to recommend capnography for all moderate and deep sedation.

Anesthesia awareness: conscious but paralyzed during surgery

Anesthesia awareness — also called intraoperative awareness or accidental awareness during general anesthesia (AAGA) — is one of the most psychologically devastating anesthesia complications. It occurs when the anesthetic drugs fail to keep the patient unconscious, but the paralytic agents (neuromuscular blockers) prevent the patient from moving, speaking, or signaling distress.

The patient may experience pain, pressure, the sound of surgical instruments, and conversation among the surgical team — all while completely unable to communicate that they are awake. Awareness episodes can last from seconds to the entire duration of surgery. The psychological aftermath is severe: studies show that up to 70% of awareness patients develop PTSD, with symptoms including flashbacks, nightmares, anxiety, avoidance of medical settings, and depression.

Anesthesia awareness occurs for identifiable and often preventable reasons: underdosing of anesthetic agents, vaporizer malfunction or empty vaporizer, disconnection of the IV line delivering the anesthetic, failure to respond to clinical signs of awareness (tachycardia, hypertension, sweating, tearing), and failure to use processed EEG monitoring (BIS monitor) in high-risk patients. High-risk situations include cardiac surgery, trauma surgery, cesarean delivery under general anesthesia, and patients with chronic opioid tolerance.

Malpractice claims for anesthesia awareness can be pursued for both the awareness event itself and the resulting psychological injuries. Ohio recognizes emotional distress damages when accompanied by physical impact or injury — and the awareness event itself (experiencing pain and surgical stimulation while paralyzed) satisfies this requirement. Mike works with both anesthesiology experts and psychiatrists to document the full scope of injury in awareness cases.

Anesthesiologist vs. CRNA: supervision and liability

In Ohio, anesthesia is provided by two categories of professionals: physician anesthesiologists (MDs or DOs with anesthesiology residency training) and Certified Registered Nurse Anesthetists (CRNAs — advanced practice registered nurses with specialized anesthesia training). Both are licensed to administer anesthesia, but their training, scope of practice, and supervision requirements differ — and these differences have significant legal implications.

Ohio law permits CRNAs to practice under the supervision of a physician (who need not be an anesthesiologist) or through a collaborative agreement. The most common practice model in Ohio hospitals is the anesthesia care team model, where an anesthesiologist supervises two to four CRNAs simultaneously, moving between operating rooms.

Liability in the care team model can be complex:

• The CRNA is liable for direct errors in their own care — wrong dose, failed intubation, failure to respond to vital sign changes
• The supervising anesthesiologist may be liable for inadequate supervision — being unavailable during a critical event, failing to approve the anesthetic plan, or supervising too many rooms simultaneously to provide meaningful oversight
• The hospital may be liable for staffing decisions — assigning one anesthesiologist to supervise an unsafe number of concurrent cases, or credentialing a CRNA without adequate qualifications

Medicare’s Conditions of Participation require that physician supervision in the care team model be “reasonable and appropriate,” meaning the anesthesiologist must be “physically present and available” — not across the hospital or performing another procedure when a complication arises. Mike investigates the staffing and supervision arrangements in every anesthesia case to determine whether the care team model was implemented safely.

Pre-operative assessment failures

The pre-operative anesthesia assessment is a critical safety step that occurs before any surgery. The anesthesia provider must evaluate the patient’s fitness for anesthesia and develop an individualized anesthetic plan. Under the American Society of Anesthesiologists (ASA) practice standards — which Ohio courts recognize as evidence of the standard of care — the pre-operative assessment must include:

• Review of the patient’s medical history, including cardiac, pulmonary, renal, hepatic, and neurological conditions
• Assessment of the airway using the Mallampati classification, thyromental distance, neck mobility, and mouth opening — to predict intubation difficulty and prepare accordingly
• Review of current medications and potential interactions with anesthetic agents
• Assessment of obesity and obstructive sleep apnea risk — both significantly increase airway management difficulty and post-operative respiratory complications
• Discussion of anesthesia risks and alternatives with the patient as part of informed consent

When an anesthesia provider fails to conduct an adequate pre-operative assessment — or conducts the assessment but fails to modify the anesthetic plan based on identified risk factors — and the patient suffers a foreseeable complication, the provider has breached the standard of care. The most dangerous scenario is the “unanticipated difficult airway” — where the provider encounters intubation difficulty that should have been predicted and prepared for during the pre-operative assessment, but wasn’t.

Informed consent for anesthesia in Ohio

Ohio law requires that patients give informed consent before anesthesia, which is separate from the surgeon’s informed consent discussion about the surgical procedure itself. The anesthesia provider must disclose the material risks of the proposed anesthetic technique — risks that a reasonable patient would want to know in making their decision.

For general anesthesia, material risks include awareness, dental damage from intubation, sore throat, nausea, aspiration, and (rarely) brain damage or death. For regional anesthesia, material risks include nerve damage, infection, hematoma, headache, and the possibility that the regional block may fail and conversion to general anesthesia may be necessary.

Under Ohio’s informed consent standard (established in Nickell v. Gonzalez), the test is whether the provider disclosed the information that a reasonable medical practitioner in the same specialty would disclose under the same or similar circumstances. If the provider failed to disclose a material risk that subsequently materialized — and the patient would have declined the procedure or chosen a different anesthetic if informed — the provider may be liable for the resulting injury even if the procedure was performed without technical error.

Epidural complications during childbirth

Epidural analgesia is the most common method of pain relief during labor and delivery. While generally safe when administered correctly, epidurals carry specific risks that require careful technique and monitoring:

• Epidural hematoma — bleeding in the epidural space that can compress the spinal cord. If not diagnosed and surgically decompressed within 6 to 12 hours, the result can be permanent paralysis. Risk is elevated in patients on blood thinners — the standard of care requires checking coagulation status before epidural placement.
• High spinal block — occurs when the epidural needle punctures the dura and anesthetic is injected into the spinal fluid, spreading to the brainstem. This can cause respiratory arrest and cardiovascular collapse, requiring immediate resuscitation. Providers must aspirate before injecting and use a test dose to detect inadvertent spinal placement.
• Maternal hypotension — epidurals commonly cause a drop in blood pressure, which can reduce blood flow to the baby. The standard of care requires IV fluid preloading, continuous blood pressure monitoring, and prompt treatment with vasopressors (ephedrine or phenylephrine) when hypotension occurs.
• Delayed emergency C-section — if a laboring patient on epidural analgesia requires an emergency C-section and the epidural is inadequate for surgical anesthesia, the anesthesia provider must rapidly convert to general anesthesia. Delays in this conversion can contribute to fetal oxygen deprivation.

Mike evaluates epidural complications in the context of both the mother’s injuries and any resulting harm to the baby. These cases often overlap with birth injury malpractice claims when anesthesia errors contribute to fetal distress or delayed delivery.

Statute of limitations and proving anesthesia malpractice

Anesthesia malpractice claims in Ohio are governed by the standard medical malpractice statute of limitations: one year from the date of injury or discovery under R.C. § 2305.113, with a four-year statute of repose. For anesthesia awareness claims, the discovery rule is particularly important — many patients initially suppress or doubt their memories of awareness, and the psychological injury may not manifest fully until weeks or months later.

The key evidence in anesthesia malpractice cases is the anesthesia record — a detailed, time-stamped document recording every drug administered, every vital sign reading, ventilator settings, fluid volumes, and any events or complications. Modern electronic anesthesia records capture data automatically from monitors, creating a minute-by-minute objective record of the patient’s physiological status throughout surgery.

An affidavit of merit from a qualified anesthesiology expert is required under Civ.R. 10(D)(2). Mike retains board-certified anesthesiologists who can interpret the anesthesia record, identify the point of departure from the standard of care, and explain to a jury exactly how the error caused the injury. The combination of objective monitoring data and expert analysis makes anesthesia cases highly fact-driven — and when the data supports the claim, extremely compelling.