A Michigan woman suffered a serious brain injury before elective surgery when the anesthesia assistant, without approval from the anesthesiologist on the case, activated a thoracic epidural just before induction. Both anesthesia providers denied negligence but, along with the hospital, agreed to pay $3.05 million to settle a malpractice suit the woman filed in Michigan circuit court.

The names of the hospital, plaintiff and defendant anesthesia providers have been withheld in public documents on the case, which was settled in July 2009.

In the suit, the 49-year-old woman, who had elected to undergo a low-anterior colon resection, alleged that the anesthesia assistant should not have "activated the epidural with 5 mm of 2% lidocaine with epinephrine" right before induction. After given the epidural and induction medications, the patient's blood pressure dropped and she went into cardiopulmonary arrest. At the time, the anesthesiologist had left the room to attend to another patient. The anesthesia assistant attempted to manage her condition for 10 minutes before calling the anesthesiologist.

The patient was successfully resuscitated, but not in time to prevent a "significant hypoxic injury" to her brain that left her permanently disabled, according to court documents.

The epidural had been placed in PACU for post-op pain control and was allegedly tested 1 hour before the surgery was to take place. The anesthesia assistant claimed that, because the patient had been moved and the epidural may have dislodged, it was appropriate for him to test it in the OR before induction. But the anesthesiologist said if he had known the assistant was going to activate the epidural again, he would have advised against it. The plaintiff maintained that the anesthesiologist was ultimately responsible for her anesthesia care and should have been aware of what was going on, court documents show.

. Both anesthesia providers maintained that it was appropriate for the assistant to try to manage the patient's situation without immediately calling for the anesthesiologist. They also claimed that the patient may have had an allergic reaction to the induction medications.

Though both anesthesia providers denied negligence, they agreed to a $3,045,000 settlement with the patient, who will require "long-term future care as a result of her injuries," court documents show.

Irene Tsikitas

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