Anesthesiologist Fails to Obtain Patient History Before General Anesthesia

This case involves an elderly man who had been suffering from a hunched back associated with advanced ankylosing spondylitis. During an MRI, a suspicious mass was identified near his liver incidentally, which prompted doctors to recommend a biopsy of the affected area. In order to perform the biopsy, an anesthesiologist recommended that the patient be put under general anesthesia. The doctor made this recommendation despite the fact that there was no known medical history for the patient. Nevertheless, the patient was taken for the procedure to be performed, where he was put under general anesthesia and intubated. Shortly after the procedure, the patient was noted to have a severe spinal fracture, which eventually proved to contribute to his death a few months later.

Question(s) For Expert Witness

1. How many times have you anesthetized a patient with ankylosing spondylitis?

2. How often do you personally take patients' medical histories before giving anesthesia?

3. What special considerations are taken for patients with ankylosing spondylitis before anesthesia?

Expert Witness Response E-006678

I have an academic interest in anesthesia for spine surgery and have developed products to protect patients having surgery in the prone position. I have treated patients with ankylosing spondylitis dozens of times and am familiar with the issues surrounding their anesthetic care. I always take my patient's medical histories; the standard of care requires that the anesthesiologist always conduct his/her own evaluation of the patient before providing an anesthetic. One must evaluate the extent of cervical spine involvement before putting a patient with ankylosing spondylitis to sleep. If they have cervical involvement, it is wise to avoid general anesthesia and intubation. If general anesthesia is required (it was not in this case), then an awake fiberoptic intubation is the safest approach.