ASA closed malpractice claims data to identify areas of morbidity, mortality and prevention thereof started in 1985. It is overseen by the Committee on Professional Liability of the ASA. The database includes 8954 cases. 42% of claims in the 1980s involved death and permanent brain injury, this dropped to 32% of claims in the 1990s. ~13% of claims involved brain injury. The primary cause of brain injury is inadequate ventilation and esophageal intubation and difficult intubation. Decreases in brain injury from 1970s to 2000 are not directly correlated with use of pulse oximetry and/or capnography. Use of these two monitors lead to a decrease in respiratory causes of brain injury and an increase in cardiovascular causes of brain injury – in particular, a decrease in esophageal intubation and inadequate ventilation as the cause of death and brain injury has been noted.
A high percentage of MAC claims involve death and brain injury (19%) – especially in the severely ill and elderly.
MAC claims: inadequate recognition of level of sedation, inadequate treatment of sympathetic blockade