Turkiye Klinikleri Journal of Forensic Medicine and Forensic Sciences

.: ORIGINAL RESEARCH
Anestezi Uygulaması Sırasında Ölümle Sonuçlanan ve Dava Konusu Olmuş Olguların Adli Tıp Açısından Retrospektif Değerlendirilmesi
RETROSPECTIVE FORENSIC MEDICINAL EVALUATION OF THE CASES RESULTED IN DEATH DURING ANAESTHESIA APPLICATION AND SUBJECTED TO LAWSUIT
Ayşegül ERTANa, Hüseyin ÖZb, Akif İNANICIc, Rabiş KESKİNa
aAdalet Bakanlığı Adli Tıp Kurumub, Anestezioloji ve Reanimasyon AD, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesic, Adli Tıp AD, Marmara Üniversitesi Tıp Fakültesi, İSTANBUL
Turkiye Klinikleri J Foren Med. 2004;1(2):67-71
Article Language: TR
Full Text
ÖZET
 Amaç : Bu çalışmada anestezi uygulaması sonucu ölümle sonuçlanarak dava konusu olan olgularda, anestezi uygulama hatalarının profilini ortaya çıkarmak, önlenebilir hataları saptamak ve güvenli anestezi uygulaması için alınması gereken önlemlere ışık tutmak amaçlandı. Gereç ve Yöntemler: Çalışmamızda; 1998-2002 yıllarını içeren dönemde, Adli Tıp Kurumu Başkanlığına gönderilen dosyalarda, anestezi uygulamasına bağlı ölüm iddiası bulunan 67 olgu incelendi. Bulgular: Altmışyedi olgunun 19unda (%28.4) anesteziye bağlı tıbbi uygulama hatası kararı verildiği, kalan 48 olguda ise (%71.6) anesteziye bağlı tıbbi uygulama hatasından bahsedilmediği görüldü. Anesteziye bağlı tıbbi uygulama hatası bulunamayan 48 olgudan 17sinde (%35.4) cerrahi uygulamanın değerlendirilmesi için diğer kurullardan görüş istendiği saptandı. Kalan 21 olguda (%43.8) mevcut bilgilerle ölüm nedeninin belirlenemediği, 5 olguda (%10.4) mevcut hastalığın etkisi ile diğer 5 olguda (%10.4) ise ilaç hassasiyetine bağlı ölümün meydana geldiği ve anestezi uygulaması yönünden hatadan bahsedilmediği belirlendi. Tıbbi uygulama hatası kararı verilen 19 olgunun 12sinde preoperatif hazırlığın eksik bırakıldığı veya hiç yapılmadığı saptandı. Oniki olgunun 4ünde mevcut akciğer ve kalp hastalığına yönelik inceleme yapılmadığı ve müdahale acil olmadığı halde olgular stabil hale getirilmeden anestezi uygulandığı, diğer 3 olguda zor entübasyon tesbit edilmesine rağmen gereken önlem alınmadığı, kalan 5 olguda ise hiçbir preoperatif hazırlık yapılmaması nedeni ile uygulamanın hatalı olduğu kararı verildiği görüldü. Kalan 7 olgudaki diğer hata nedenlerine bakıldığında, 1 olguda anestezi sırasında oksijen yerine yanlış gaz bağlandığı, 1 olguda ameliyat sırasında %50 dekstroz takıldığı, 1 olguda yüzüstü pozisyonda entübasyon tüpünün yerinden çıktığı ve farkedilmediği, 1 olguda özefagus entübasyonu yapıldığı ve farkedilmediği, 1 olguda cerrahi tarafından infiltratif adrenalin uygulaması sırasında elektrokardiografi monitörizasyonunun yapılmadığı, 1 olguda ameliyat sonrası takibinin yapılmadığı, 1 olguda ise hata nedeninin raporda yer almadığı saptandı. Sonuç: Çalışmamızda tıbbi uygulama hatalarının çoğunun preoperatif dönemde hastaların yeterli hazırlanmaması (%63.1) ve intraoperatif dönemde uyulması gereken temel kurallara uyulmaması (% 31.5) sonucu ortaya çıktığı dikkate alındığında uygulanacak standardizasyonun uygulama hatalarının azalmasına katkıda bulunacağını düşünmekteyiz.

Anahtar Kelimeler: Anestezioloji, tıbbi uygulama hatası, adli tıp
ABSTRACT
 Objective: In this study, we to reveal the profile of anaesthesia application errors, to establish the preventable errors and to shed light on the measures that could be taken for secure anaesthetic application in the cases which had resulted in death during anaesthesia application and subject to lawsuit. Material and Methods: Sixty-seven cases which were evaluated by Council of Forensic Medicine with the claim of death caused by the anaesthesia application belong to the period 1998-2002. Results: It has been detected that there was adjudication about medical application errors due to anaesthesia in 19 cases (28.4 %) and no medical application errors due to anaesthesia had been mentioned in the rest 48 cases (71.6 %). In the 17 of 48 cases (35.4 %) which have no medical application error due to anaesthesia, it has been detected that evaluation of surgical operation has been requested from the other committees and in the rest 21 cases (43.8%) cause of death could not be identified with the current information. The reason of death was ongoing disease in 5 cases (10.4 %), drug sensitivity in other 5 cases. There was not mentioned any kind of anaesthesia application error in these 48 cases. It was established that pre-operative preparation was incomplete or absent in 12 of 19 cases sentenced to medical application errors. It is detected that it was concluded as a faulty medical application in 4 of 12 cases which no evaluation of current lung and heart disease had been made and anaesthesia implemented even though it had not been urgent, in 3 cases which measures required had not been taken in spite of determination of diffucult entubation, and in the rest 5 cases which no pre-operative preparation had been made. Inspection of the medical mistakes in the rest 7 cases revealed that wrong gas had been implemented in 1 case, 50 % dextrose had been applied during operation in 1 case, entubation tube was dislocated at prone position in 1 case , esophageal intubation had been performed in 1 case, ECG was not monitorised during infiltrative administration of adrenalin by surgeon in 1 case, and post-operative follow-up had not been performed in 1 case. In 1 case the reason of the mistake did not take place on the records. Conclusion: We have detected that most of the medical application errors (63.1%) were originated from incomplete pre-operative assessment, absence of precautions for the current disturbances, and most of the rest (31.5%) was absence of attention during intra-operative period. As a consequence of these, it can be concluded that medical practice errors due to anaesthesia could be reduced by standardization of anesthesiological procedures.

Keywords: Anaesthesiology, malpractice, forensic medicine

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