What is anaesthetic negligence?
Anaesthetic negligence occurs when an anaesthetist — or a member of the anaesthetic team including anaesthetic nurses — provides care before, during, or after an operation that falls below the standard of a reasonably competent anaesthetist, and that failure causes harm. The Bolam test applies to anaesthetic care in the same way as all other clinical specialties.
Common types of anaesthetic negligence
Awareness under general anaesthesia
Accidental awareness during anaesthesia — the patient is conscious during surgery but paralysed and unable to communicate — is one of the most traumatic anaesthetic complications. NAP5 (5th National Audit Project) estimated it occurs in approximately 1 in 20,000 general anaesthetics. Where it results from a failure to monitor anaesthetic depth adequately, use appropriate agents, or respond to clinical signs of arousal, a claim may succeed. Awareness commonly causes PTSD.
Failed intubation and airway management
Airway management is the most critical anaesthetic skill. Difficult airways must be identified and managed using Difficult Airway Society guidelines. Failure to manage a difficult airway, failure to have emergency equipment available, or failure to follow established protocols when intubation fails can cause hypoxic brain injury or death.
Drug errors in anaesthesia
Administering the wrong drug, the wrong dose, or drugs to which the patient is known to be allergic are serious errors. Examples include giving a paralytic agent without adequate anaesthetic cover (awareness), administering the wrong volatile agent, or administering a drug to which the patient has a known allergy.
Failure to take a pre-operative anaesthetic history
The anaesthetist must identify factors that affect anaesthetic risk: allergies, family history of malignant hyperthermia, obstructive sleep apnoea, previous anaesthetic problems, and current medications. Failure to take an adequate pre-operative history, with consequent harm from a preventable complication, may give rise to a claim.
Anaesthetic positioning injuries
Patients are positioned on the operating table in positions they cannot control. Pressure injuries, nerve stretch injuries, and compartment syndrome can result from inadequate positioning care during long procedures. The ulnar and common peroneal nerves are particularly vulnerable.
Post-anaesthetic respiratory depression not monitored
In the post-anaesthetic recovery room, patients are at risk of respiratory depression from residual anaesthetic drugs and opioids. Inadequate monitoring — or failure to respond to signs of respiratory compromise — can cause hypoxic injury.
Epidural and spinal complications
Epidural haematoma, epidural abscess, dural tap (with subsequent headache), and direct cord injury from neuraxial block. Where these occur due to technique errors, a claim may arise.
Awareness under anaesthesia — a specific claim type
Claims for anaesthetic awareness are both a negligence claim and a consent claim. Under Montgomery, patients must be warned that awareness — while rare — is a material risk of general anaesthesia, and told what can be done to reduce the risk. Where a patient was not warned and suffers awareness-related PTSD, a consent-based claim may succeed even without proof of technique failure.
Frequently asked questions
Can I claim if I was aware during surgery?
Yes — on two possible bases: the anaesthetic technique was below the required standard causing inadequate depth; or you were not warned of the risk of awareness before surgery (a consent claim under Montgomery).
What if there was an anaesthetic emergency and the team did not follow the correct protocol?
Failure to follow established protocols for anaesthetic emergencies — difficult airway, anaphylaxis, malignant hyperthermia — may constitute a breach of the required standard.
Can I claim if the anaesthetist missed my allergy in the notes?
Yes — if the allergy was recorded in the notes and should have been identified during the pre-operative assessment.
Related guides
- Surgical negligence claims
- Brain injury compensation claims
- Nerve injury compensation claims
- Medical negligence claims — complete guide
Sources & further reading
Primary statute, case law and regulator guidance referenced in this article.