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Year : 2018  |  Volume : 62  |  Issue : 7  |  Page : 562-563  

Document for patient's sake.... for your colleague's sake! Document.... for GOD'S sake!!

Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Web Publication11-Jul-2018

Correspondence Address:
Dr. Swati Chhabra
Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ija.IJA_272_18

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How to cite this article:
Chhabra S, Bhatia P, Mohammed S, Kumar R. Document for patient's sake.... for your colleague's sake! Document.... for GOD'S sake!!. Indian J Anaesth 2018;62:562-3

How to cite this URL:
Chhabra S, Bhatia P, Mohammed S, Kumar R. Document for patient's sake.... for your colleague's sake! Document.... for GOD'S sake!!. Indian J Anaesth [serial online] 2018 [cited 2021 Jan 20];62:562-3. Available from: https://www.ijaweb.org/text.asp?2018/62/7/562/236449


Documentation of anaesthesia care is important for ensuring continuity of care, audit, quality improvement and medicolegal issues. We report a scenario where lack of proper documentation during previous surgery created a dilemma.

A 45-year-old male attended the pre-anaesthesia evaluation clinic for an elbow surgery. A year back, he was operated for mid-shaft left femoral fracture. Eight months later, during femur implant removal, 'reportedly' under local anaesthesia, he had convulsions and cardiac arrest. He was revived, tracheally intubated and shifted to another hospital receiving mechanical ventilation. No abnormality was detected on computed tomography head. He was weaned from mechanical ventilation and trachea was extubated on the 3rd day and the patient was subsequently discharged home. The surgical notes of the procedure read 'patient had seizures and arrest, was revived and intubated by anaesthetist and shifted to another hospital for further management'. With just these lines, no information could be attained such as the dose and name of local anaesthetic and any concomitant sedative/analgesia or measures taken to 'revive' the patient. The next hospital also provided supportive care and had incomplete details of the incident.

We postulated a few probable causes such as local anaesthetic systemic toxicity (LAST), hypoxemia due to sedatives/analgesics, anaphylaxis and pulmonary thromboembolism (PTE)/fat embolism. As he was asymptomatic since previous hospital discharge and had normal routine investigations, we accepted the patient for surgery as American Society of Anesthesiologists physical status 1. We did not further investigate the probability of PTE or fat embolism because he was asymptomatic. Anaphylaxis might have occurred, so we planned a supraclavicular brachial plexus block to limit the number of required medications. Intradermal sensitivity test for ropivacaine was done which was negative. We discussed the probability of recurrence of anaphylactic reaction with the patient and reassured him. Prior to surgery, emergency airway management equipment and resuscitating medications were kept ready. Supraclavicular brachial plexus block was performed under ultrasound guidance to increase the success rate and reduce the required volume of 0.5% ropivacaine. The procedure was uneventful, but a question remains in our mind regarding the sequence of events in the previous surgery to reach a logical reason.

Patient safety forms the core of anaesthetic practice. Although anaesthesia has become safer over the decades with a steep decline in anaesthesia-related mortality, critical events continue to occur, which might or might not be life-threatening.[1] Anaesthesiologists might refrain from reporting such events due to medicolegal implications. The Anesthesia Patient Safety Foundation (APSF) endorses an 'Adverse Event Protocol' emphasising 'Document Everything'.[2] Research involving voluntary reporting of critical events shows benefits in outcomes and thus critical incident reporting is a part of Quality Improvement Programmes at various institutes.[3],[4]

In an Indian context, 'Guidelines for Documentation of Anesthetic Care' are provided by the Indian College of Anaesthesiologists in 'Practice Guidelines in Anesthesia'.[5] We suggest that anaesthetic technique and critical event details should be specifically mentioned in the discharge summary so that this information can be successfully shared with patient's future medical caregivers. The All India Difficult Airways Association has proposed a difficult airway alert form to be given to the patient since this information would be crucial if patient requires medical care, especially a surgery in future.[6]

We request all anaesthesiologists to document anaesthetic care well and to include all the critical events. Furthermore, providing necessary information of critical events and details of its management, to patient and family in both verbal and written manner, would not only help our colleagues, but also ensure safety and quality of patient care.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Li G, Warner M, Lang BH, Huang L, Sun LS. Epidemiology of anesthesia-related mortality in the United States, 1999-2005. Anesthesiology 2009;110:759-65.  Back to cited text no. 1
Anesthesia Patient Safety Foundation Resources. Available from: https://www.apsf.org/resources_safety_protocol.php. [Last accessed on 2018 Apr 07].  Back to cited text no. 2
Mason KP, Green SM, Piacevoli Q; International Sedation Task Force. Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: A consensus document from the World SIVA International Sedation Task Force. Br J Anaesth 2012;108:13-20.  Back to cited text no. 3
Gupta S, Naithani U, Brajesh SK, Pathania VS, Gupta A. Critical incident reporting in anaesthesia: A prospective internal audit. Indian J Anaesth 2009;53:425-33.  Back to cited text no. 4
[PUBMED]  [Full text]  
Bhatia P, Chhabra S. Guidelines for documentation of anesthetic care. In: Malhotra SK, editor. Practice Guidelines in Anesthesia-2. 1st ed. New Delhi: Jaypee Brothers; 2018. p. 17-26.  Back to cited text no. 5
Myatra SN, Shah A, Kundra P, Patwa A, Ramkumar V, Divatia JV, et al. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults. Indian J Anaesth 2016;60:885-98.  Back to cited text no. 6
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