Neonatal Injury and Resuscitation: A Liability for Anesthesiologists? An Update From the Anesthesia Closed Claims Project

Authors: Karen B. Domino, M.D., M.P.H.; Joanna M. Davies, M.B.B.S., FRCA

ASA Monitor 02 2017, Vol.81, 16-17.

An anesthesiologist was called STAT for an emergency cesarean section for severe fetal bradycardia. The anesthesiologist rapidly anesthetized the mother using a rapid-sequence induction and a floppy, pale, non-responsive baby was delivered. An obstetric nurse and family practitioner attempted to stimulate the baby and placed an oxygen mask on the baby. They began bag-mask ventilation and chest compressions due to persistent bradycardia and absent respiration after one min. The anesthesiologist was asked to assist with endotracheal intubation, while the family practitioner monitored the mother. The anesthesiologist intubated the baby and administered epinephrine down the endotracheal tube. The anesthesiologist then resumed care of the mother. The baby died the following day. A neonatologist expert witness criticized the anesthesiologist for failure to properly resuscitate the baby, including delay in resuscitation, inadequate dose of epinephrine, failure to place an umbilical line and failure to follow the American Academy of Pediatrics newborn resuscitation guidelines. The case against the anesthesiologist was dismissed. He was acting as a Good Samaritan with primary responsibility for the mother’s care and his standard of care in resuscitating the baby was appropriate for a generalist anesthesiologist.