Spinal Anaesthesia administered by Surgeon : Hospital fined Rs 20 lakh

Rajasthan : A private hospital in Rajasthan has been asked to pay a compensation of Rs 20 lakh by the state consumer forum to the family of a deceased patient who died allegedly due to anaesthesia overdose during a minor surgery at the said nursing home.

The case goes back to 2009 when a patient( deceased) consulted Dr. C.K. Sharma at his nursing home in Gulab bag, Karauli with complaints of abscess in his anus. After prescribing him some tests and treating him with some medication for a few days, the doctor advised him to undergo a minor surgery. However, during the surgery, the patient died allegedly due to spinal anaesthesia overdose, yet no records were there to show what transpired in the OT

The patient's family filed a complaint with the police after which a medical board of four doctors was constituted who did an autopsy of the deceased and gave its finding that

“cause of death of Sumer Lal S/o of Ram Gopal Sharma is due to sudden …………respiratory arrest resulting from spinal shock sufficient to cause death in ordinary course of life”.

However, it is reported that after one year of the incident the Superintendent of Police Kaurali requested the Joint Director of Medical and Health Department to constitute another medical board consisting doctors outside the Kaurali to opine about the cause of death of the deceased. On 10.01.2011 a medical board consisiting of Dr. Akhilesh Srivastava Jr. Specialist Surgery, Dr. K D Sharma Specialist Medicine, Dr. Dinesh Bansal Jr. Specialist Surgery, Dr. Shyamsunder Agarwal Sr. Specialist Ortho, Dr. Mukesh Gupta Medical Jurist all working in RBM Hospital, Bharatpur submitted its report and opined that there was no negligence on the part of the opposite party and it was also not necessary to call a Anesthetist at the time of administering anesthesia to the deceased. On the basis of this report the police filed a final report and closed the case

Aggrieved the patients family  approached the consumer court, alleging medical negligence mainly on two grounds i.e. first the deceased was given overdose of anesthesia and second the anesthesia was administered without the aid and help of any expert anesthetist.

After listening to the arguments the court quoting literature observed

Spinal anesthesia is an alternative to a general anesthesia and can be used for most operations below the waist. A spinal anesthesia is performed by an anesthetist. A very fine needle is inserted into the middle of the lower back and local anesthetic is injected through the needle in to the fluid that surrounds the spinal cord.. It further states that spinal anesthetic wil be performed in the anesthetic room or in theatre. Before the spinal anesthesia is given the anesthetist will put a drip in patient’s hand and patient will be attached to a monitor (ECG, blood pressure and oxygen saturations

spinal anesthesia is an important anesthetic technique in anesthesiology. Among possible spinal block anesthesia related complications cardio pulmonary arrest is the most serious. The increased knowledge on the physiology of spinal anesthesia together with use of less toxic local anesthetics and improved monitoring incidence of cardiac arrest can be reduced. The effects of spinal block anesthesia on the cardiovascular system include reduction of blood pressure and central venous pressure. The sympathetic blockade prooked by spinal anesthesia causes significant peri pheral vasodilation (widening of blood vassels) which results in bradycardia.

It further suggests the precautionary measures like early diagnosis and effective and aggressive treatment are necessary when facing significant bradycardia during spinal anesthesia. It is essential to monitor the respiration, pulse and blood pressure closely. The blood pressure can fall precipitously following induction of spinal anesthesia. Bradycardia is quite common during spinal anesthesia .Patient should be well hydrated before local anesthesia is injected and should have an intravenous infusion in place so that further fluids or vasoconstrictions can be given if hypotension occurs. Hypotension and bradycardia should be treated with intravenous fluids, atropine and vasopressors.Treatment if not started quickly the combination of hypoxia, bradycardia, hypotension may result in cardiac arrest.

The court clearly observed that anaesthesia should have been given by qualified anaesthetist