Anestesia e Pesquisa Clínica
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Excellent Experts Versus Witnessed Experts; Who Can Make the Difference Between Justice and Negligence?

Ashraf EL-Molla, Fawzia Aboul Fetouh, Rashed Alotaibi, Muteb Alotaibi, Shaker Youssif, Yasser Ali, Yehya Alwahbi, M. Taha, Shagun B. Shah, and Vakhtang Shoshiashvili

Introduction: Anesthesia is the major cause of death and disability in perfectly healthy young patients who are undergoing uncomplicated surgery. In medical practice, the common source of medicolegal proceedings is negligence. Negligence is proved in the court by assigning witnessed experts to handle the case and make fair
scientific opinion. We were asked by the defendant to investigate the case and give an expert opinion whether he/she is guilty and provide our evidence based medical opinion for possible objection of the current decision. We will discuss medicolegal aspects in anesthesia and the standards of care by which anesthesiologists should abide as well as define malpractice. The role of expert witness will be explained and the ethical guidelines to be followed are outlined.

Case Presentation: 13-month old male patient, weighing 11 kg, underwent general anesthesia for lacrimal duct surgery, inhalation induction by sevoflurane and 0.9 mg/kg rocuronium were used to facilitate endotracheal intubation as well as intravenous fentanyl 2.27 mcg/kg and intramuscular pethidine 1.36 mg/kg were administered as intraoperative analgesia. Surgical duration and Post Anesthesia Care Unit (PACU) stay were 45 minutes (mins) and 80 mins respectively. In the ward, the patient stayed for 40 mins followed by cardiac arrest and resuscitation for 5 mins with residual brain damage. The court ’ s decision was against the anesthesiologist who was considered negligent as he did not administer reversal for the neuromuscular blocking agent and also the witnessed experts considered the respiratory depression is due to narcotic analgesic.

Conclusion: Our expert opinion relied on evidence-based medicine, related to a critical literature review, which indicates that this case should be investigated in the frame of pharmacodynamic/pharmacokinetic of rocuronium, neostigmine, fentanyl, and pethidine as well as the clinical documentation of both recovery and ward’s staff in addition to patient ’ s father statements. Finally, according to our critical review; the court’ s decision was: The anesthesiologist is not negligent and will not pay the previously determined financial compensation.