Surgical errors are among the top five medical errors, and anesthesia errors are among the most common surgical errors. Anesthesia involves maintaining the airway, ensuring vital signs remain at acceptable levels and blocking pain and sensation during medical procedures. Proper administration is critical to avoid errors. In fact, an estimated 57% of anesthesiologists can expect to be sued for malpractice during their career.
Anesthesia errors can occur not just during surgery but also pre- and postoperative. Furthermore, hospital OR physicians are not the only medical professionals at risk of anesthesia errors medical malpractice suits. In fact, because outpatient facilities often lack specialized staff, training, and equipment to deal with anesthesia-related emergencies, according to one study, the incidence of Non Operating Room Anesthesia (NORA) claims is substantially higher than those of OR claims. Defective equipment and malfunctioning anesthesia equipment can contribute to anesthesia blunders and patient harm.
As with other types of medical malpractice, human error, equipment failures, and poor communication are among the causes cited in anesthesiology claims. Anesthesia errors are often preventable and can stem from human factors, communication breakdowns, or equipment issues. Understanding how and why errors occur is key to prevention. Below, we’ll look at various types of anesthesia, the most common anesthesia errors, and risk-reduction strategies that improve patient safety while minimizing your liability.
All anesthesia has the same basic purpose: to maintain the airway, ensure vital signs remain at acceptable levels, minimize or eliminate patient pain and relax the patient’s body during a medical procedure. The correct selection and administration of anesthetic agents, along with the use of reliable anesthesia delivery systems, are essential to ensure patient safety and prevent complications. Different procedures call for different types of anesthesia, each of which has its own risk profile.
Modern anesthesia safety protocols, as of 2026, incorporate both advanced technology and standardized human procedures to minimize risks associated with anesthesia drugs.
General anesthesia renders the patient unconscious and their body immobile, impairing the ability of essential body functions, including the respiratory and cardiovascular systems. As a result, the patient’s heart rate, breathing, and other vital signs must be monitored the entire time they’re unconscious and while the anesthesia is being reversed, bringing the patient back to consciousness. Insufficient anesthesia can result in anesthesia awareness, a rare but traumatic event where the patient remains conscious during surgery. Anesthesia awareness occurs when a patient remains conscious but cannot communicate, which can lead to long-term psychological effects.
Because general anesthesia affects just about every one of a patient’s physical systems, it has the highest risk profile. Common risks such as post-surgery nausea and a sore throat from the endotracheal tube are almost always temporary. Rarer but more serious risks include nerve damage, heart attack and other cardiovascular events, hypoxia, and postoperative cognitive dysfunction, particularly among older patients. Too much anesthesia can lead to severe complications such as organ damage or death, highlighting the importance of proper dosing. Overall the risk of death is estimated at one in 100,000 to 200,000 procedures, and among healthy patients having routine procedures, it’s as low as one in 1 million.
When it’s preferred that the patient be awake but a local anesthetic won’t provide sufficient pain relief for a large area of the body, doctors will administer regional anesthesia. Most regional anesthesias are nerve blocks such as epidurals, commonly used to provide pain relief during childbirth while enabling the patient to remain awake enough to push.
Proper anesthesia administration is crucial during regional blocks, as administering anesthesia requires significant expertise to minimize risks and ensure patient safety.
The most common risks of regional anesthesia are pain, bruising, or itching where the anesthesia was injected. More significant but less common risks include neurological injuries such as long-lasting or permanent numbness or weakness, which occurs an estimated 2–4 times per 10,000 nerve blocks. And sometimes the nerve block fails, requiring the patient to receive general anesthesia.
Breast biopsies, root canals, and Mohs surgeries are just a few procedures for which practitioners administer local anesthesia. Typically injected, it temporarily blocks nerve endings only in that small area of the body, leaving the patient otherwise unaffected.
Local anesthesia is safer than regional and general anesthesia, with the most common risks being soreness, bruising, or swelling at the injection site. However, Local Anesthetic Systemic Toxicity (LAST), which can be fatal, is believed to occur in one per 1,000 peripheral nerve blocks. Although rare, adverse reactions and adverse drug events can also occur during local anesthesia, making prompt recognition and management essential to prevent serious patient harm.
Patients under MAC are sometimes but not always unaware, depending on the sedation level:
Regardless of sedation level, patients’ vital signs still need to be closely watched, as this type of anesthesia does relax the cardiovascular, respiratory, and other body systems. Cardio and respiratory issues such as bradycardia, tachycardia, breathing stoppage, and airway blockage are not uncommon. A rarer but even more significant risk is severe hypoxia. Proper monitoring is essential during MAC to ensure patient safety, and it is critical to properly monitor patients to prevent anesthesia errors and related injuries. Continuous monitoring involves vigilant observation of vital signs and immediate response to any changes during surgery.
Private practice settings that administer anesthesia range from dental offices to ambulatory surgical centers. Unlike hospitals, these NORA locations typically lack ICUs, specialists, and other emergency resources. Hospitals are also much more likely to have an anesthesia care team model in place, helmed by a physician anesthesiologist directing certified registered nurse anesthetists (CRNAs) and anesthesiologist assistants. Conversely, in many jurisdictions CRNAs can practice in NORAs without physician oversight.
Anesthesia errors can occur during hospital admissions as well as in outpatient settings, making vigilance essential during all medical procedures involving anesthesia.
Given that hospitals typically handle riskier, more complex patients and procedures, it’s difficult to compare their rate of anesthesia errors with those of NORA locations. However, one study found that the average anesthesia malpractice payment for NORA procedures was 44% higher than for hospital procedures, because of the higher rate of catastrophic injuries.
The complexity of anesthesiology leaves it open to myriad opportunities for mishaps. Anesthesia mistakes can occur for a variety of reasons and understanding how anesthesia errors occur is essential to prevention. These errors can result in serious harm to patients. Implementing standardized protocols and checklists is a proven strategy to minimize anesthesia errors. Below are the most common types of anesthesia errors.
Medication errors during general anesthesia are as high as 12 per 1,000 procedures, according to one report. And that doesn’t include errors during regional and local anesthesia and MAC.
This class of anesthesia errors encompasses:
These airway management errors can lead to breathing difficulties and other serious complications.
Inadequately tracking heart rate, ETCO₂, oxygen saturation, blood pressure, and other vitals sits at the crux of monitoring-based anesthesia errors. Proper monitoring is essential to maintain adequate oxygenation and prevent brain damage during anesthesia. Advanced monitoring systems provide real-time data on patient vital signs, enhancing anesthesia safety.
Technological safeguards like advanced alarms are necessary for ensuring patient safety during anesthesia. Even when the medical staff appear to be tracking the patient properly, uncalibrated and dysfunctional equipment can lead to monitoring failures. Alarm fatigue and inadequate staffing are other causes. Hiring qualified professionals on a locum tenens basis can help improve staffing levels.
An inadequate pre-op assessment might include failure to take a complete patient's medical history or to conduct a thorough physical exam. The WHO Surgical Safety Checklist ensures all team members have verified the patient's medical history and equipment functionality before procedures.
Rushing through an assessment can result in overlooking drug interactions, missing allergies, failing to anticipate difficult airways and other anesthesia-related risk factors, and failing to adjust medications and procedures, particularly for geriatric, pediatric, and pregnant patients.
Failure to obtain or properly document a patient’s informed consent is not only unethical but also a common source of malpractice claims. Physicians must discuss and document anesthesia risks, specific patient risks, and possible alternatives to protect themselves from anesthesia errors and medical malpractice suits.
Private practice settings often lack the emergency airway equipment common to hospitals. Similarly, NORA settings typically do not have a sizable anesthesia team led by a physician anesthesiologist. Instead they may be understaffed or overly reliant on CRNAs and assistants who might over-sedate patients or fail to quickly identify and address complications.
The presence of highly trained anesthesia providers and other vigilant healthcare professionals is critical in preventing anesthesia errors and ensuring patient safety in these environments.
Anesthesia errors related to equipment failure, poor maintenance, and insufficient pre-op testing include:
Using defective equipment during anesthesia can constitute medical negligence and compromise patient safety. Issues with equipment can disrupt anesthesia delivery, leading to safety risks and procedural delays.
Hypoxia, hypotension, anaphylaxis, laryngospasm, malignant hyperthermia: These are among the anesthesia related complications that can injure and kill patients when not immediately detected and rectified by medical professionals. They can occur after the procedure as well as during; delayed emergence from anesthesia, for instance, often signals potentially life-threatening issues. Delayed recognition of these complications can lead to serious complications and increase the risk of patient harm.
The possibility of anesthesia errors exists just about any time anesthesia is administered. However, several scenarios are more prone to malpractice claims. Teamwork and clear communication among healthcare professionals and healthcare providers are critical in high-pressure environments like operating rooms to ensure patient safety.
Medical professionals call giving anesthesia to the wrong patient, for the wrong procedure, or for the wrong body part a never event. In other words, surgical errors like these should never happen. Anesthesiologists can be just as liable as the other members of the team for failing to follow preventive protocols and contributing to negligence.
Improperly placed injections that result in trauma to nerve sheaths lead to brachial, femoral, and sciatic plexus injuries, among others. Proper use of ultrasound guidance can reduce the chances of these occurrences. Irritation from the anesthesia itself or other chemicals and compression of a nerve due to bleeding are related types of anesthesia errors.
Incorrect epidural dosages and improper placement of the injections can result in birth injury lawsuits against anesthesiologists and other team members. So can delays in converting from regional to general anesthesia when complications arise, particularly when these lead to oxygen deprivation for mother or child.
The failure to identify respiratory depression, hypoxia, and other signs of patient distress in the post-anesthesia care unit can be the basis of malpractice claims. Inadequate monitoring, faulty communication among staff, and medication mismanagement are typically at the root of such anesthesia errors. The premature discharge of patients can also open medical professionals to liability, sometimes even when the patient left against medical advice.
Patients admitted to ERs are often physically or mentally unable to provide vital polypharmacy and co-morbidity information, resulting in medical professionals administering incorrect dosages and medications. Even when ER teams obtain that data, however, improper monitoring, poor communication among staff, and inadequate documentation can result in emergency room errors for which anesthesiologists may be liable.
Anesthesia errors often result from poor staffing, equipment snafus, or faulty workflows, or a combination thereof. Lack of communication is also a primary cause of anesthesia errors and can lead to serious mistakes during surgeries.
Poor communication and handoffs among staff and rushed evaluations can easily contribute to anesthesia errors. So can missing or inadequate private-practice protocols, such as an inconsistent approach to charting by exception. On the other hand, charting with a jury in mind can minimize errors and claims alike.
Although anesthesiologists are often absent from lists of physician burnout by specialty, a survey found two-thirds were at a high risk of burning out. Inadequate staffing levels resulting in excessively long shifts, anesthesiologists having to cover multiple rooms simultaneously, and a lack of trained support staff contribute to anesthesia errors as well as burnout and exhaustion.
Only medical professionals trained and credentialed to perform sedation are legally permitted to do so, yet instances still arise where physicians administer anesthesia despite lacking formal training. In addition, anesthesia errors medical malpractice claims can arise from little or no supervision of CRNAs and anesthesiology assistants.
Outdated monitors, missing EMR medication-safety systems, and a lack of decision-support tools such as AI-guided ultrasound are potentially dangerous technology gaps.
Medical consequences of anesthesia errors can range from mild and temporary to severe and permanent.
Among the most significant:
Anesthesia errors can also result in permanent disability and severe complications, such as respiratory depression and cardiovascular instability, underscoring the seriousness of these outcomes.
For physicians in private practice, medical malpractice suits are the primary legal consequence of anesthesia errors. Medical malpractice cases involving anesthesia errors can result in claims for medical expenses, lost wages, pain and suffering and other damages.
As well as tort liability, financial and reputational damage, such suits can lead to temporary or permanent loss of licensure and occasionally criminal charges.
To prove any medical malpractice claim, including anesthesia claims, the plaintiff needs to establish four key elements.
Proving that an anesthesia error was the result of malpractice requires a thorough investigation and the presentation of evidence.
Among the most common allegations cited in anesthesia malpractice claims:
Demonstrating a breach of the standard of care typically involves presenting testimony from other professionals in the field of anesthesia.
While anesthesiologists pay out roughly a third as many malpractice claims as surgeons, 10% of those payouts exceed $1 million.
There has also been an overall increase in nuclear verdicts i.e. jury awards of more than $10 million. Recent nuclear verdicts in an anesthesia malpractice case include a Connecticut jury awarding the family of a patient $15.4 million in July 2024, agreeing that the doctors at an outpatient clinic failed to respond to cardiorespiratory collapse while she was under anesthesia, and the May 2025 award of more than $60 million in New York State to a patient who was permanently paralyzed following the misadministration of an epidural medication.
Medical malpractice rules by state vary, affecting liability in anesthesia cases. Some states have caps on certain types of damage payouts; others have strict requirements regarding expert witnesses. In some jurisdictions, vicarious liability for CRNAs can result in supervising anesthesiologists, surgeons, and hospitals being held responsible for a CRNA’s actions. Informed consent laws and statutes of limitations also differ from state to state.
To mitigate the risk of anesthesia errors, private-practice physicians can implement numerous strategies and protocols for use before, during, and after procedures. Advancements in anesthesia practice, such as updated protocols and technological innovations, also play a key role in reducing errors and improving patient safety.
Pre-operative risk assessment forms require gathering a patient’s complete medical history, medications, and allergies, and recording vital statistics and physical findings. Practitioners can then use the information for ASA (American Society of Anesthesiologists) scoring, which rates the patient’s risks of complications. Risk assessment forms also facilitate medication reconciliation, minimizing the chances of unwanted drug interactions.
For example, an increasingly common issue in medicine today is patients using GLP-1 agonists and ensuring that they fast before a procedure for longer than the standard period of time due to delayed gastric emptying. Pre-operative airway evaluation should also be standard.
Surgery safety checklists help verify that all equipment is functional and that team members are following operational and communication procedures. Continuous ETCO₂ monitoring and tracking of other vital signs should be among these standard procedures, along with double-checking drugs and syringes and using standardized color-coded labeling to avoid accidental applications of similar-looking medications.
Automated systems can further enhance the safety and accuracy of the delivery of anesthesia during surgery by minimizing human error and supporting effective communication among the anesthesia team. Beyond implementing and following procedures, proper staffing ratios help prevent anesthesia errors resulting from inattention and fatigue.
Post-sedation monitoring is imperative, with Aldrete scoring reducing the risk of prematurely discharging patients. This is a tool used in post-anesthesia care (PACU) to assess a patient’s readiness for discharge by scoring five criteria: activity, respiration, circulation, consciousness and oxygen saturation.
Patient red-flag education, informing patients of symptoms and other warning signs they need to report to medical professionals after discharge, also mitigates risks. Should patients leave against medical advice or refuse to follow postoperative treatment, sending a patient dismissal letter can minimize potential liability.
Pre-anesthesia evaluations, equipment checks, intra-operative records of patient monitoring, administration of medications, and postoperative tracking must be complete, legible, with time stamps and signatures. Failure to document phone calls and other interactions, lack of detail, incomplete intervention logs, and even the use of non-objective language can lead to documentation malpractice claims. Improper alterations of the records is also a high risk factor for liability.
Training all employees, including office staff, on sedation emergency procedures is one way to minimize risk. Others include code-blue rehearsals, difficult-airway drills, and practicing responses to malignant hyperthermia.
What is the basis for most liability claims in medicine depends not only on medical specialty but also on type and site of practice. Insurers often scrutinize office-based providers and claims more heavily than hospital-based anesthesia claims for several reasons.
During the underwriting process, insurers weigh predictive risk factors from claims data along with key signals such as staffing patterns, documentation quality, case mix, and claims history from each applicant. AI underwriting uses advanced algorithms to collect and analyze large sets of these and other data more accurately and quickly than people can alone.
By reducing human error, identifying otherwise-undetectable patterns, and uncovering potential application insurance fraud, AI-driven underwriting enables medical professionals to quickly get fairly priced coverage tailored to their unique risk profile.
Anesthesia errors are a subset of surgical errors, which are among the top five most common medical mistakes. Estimates vary hugely, ranging from one anesthesia error per 90 procedures to one per 5,000 procedures.
The most common anesthesia errors include medication and dosage errors, airway management errors, monitoring failures, equipment problems, inadequate pre-operative assessments, and delayed recognition of complications.
Among the situations leading to anesthesia errors are system and workflow issues including poor communication among staff members; fatigue and burnout caused by inadequate staffing; poor training and supervision; and outdated or poorly maintained equipment.
Although there are no definitive numbers regarding the incidence of brain injuries resulting from anesthesia errors, sources such as the Anesthesia Patient Safety Foundation say that permanent brain damage is rare. Those rare injuries typically arise from hypoxia, hypotension, and stroke due to airway obstruction, fluctuations in blood pressure, cardiac arrest, and adverse drug reactions.
When an anesthesiologist is not overseeing or administering sedation, the treating surgeon, the hospital or practice, and nurses and other staff responsible for monitoring patients or administering medication can be held liable for anesthesia errors. On some occasions the equipment and drug manufacturers might be held liable as well.
Liability for anesthesia errors involving both a CRNA and a supervising physician can fall on both. State regulations often help determine who bears responsibility and to what degree, depending on the type of error and each party’s contribution.
Detailed, legible documentation including pre-op assessments, anesthesia records, intra-operative records of patient monitoring and medication administration, postoperative recovery notes, and discharge instructions can offer vital protection against anesthesia-related malpractice claims.
Anesthesia errors run the gamut from incorrect dosages to airway management flaws to equipment failures. Poor communication can contribute to these errors, as can inadequate training, staffing shortfalls, equipment failures, and an absence of well-defined protocols. Thorough checklists and documentation, improved training and drills, consistent patient and equipment monitoring, and proper staffing ratios are among the tools providers can implement to minimize risk.
Even the most rigorous tactics cannot eliminate risk altogether. That’s why physicians require medical malpractice insurance. Indigo’s AI-powered malpractice insurance can quickly get you the best coverage for your practice so that you are protected against liability from anesthesia errors and other claims.
Contact us today to learn how we can help protect you.
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