Awareness: practice, standards, and the law

Increased attention in recent years in both the academic literature and general media on awareness during general anaesthesia has raised the spectre of an increase in the liability burden of anaesthesia awareness. Liability will be different around the world, largely influenced by factors such as the presence of no-fault compensation systems for medical complications in some countries and the characteristics of the common law tort systems in others, such as the United States. A review of the largest single source for liability data, the American Society of Anesthesiologists' Closed Claims database, found the proportion of anaesthesia malpractice claims and claim payment amounts for awareness did not increase during the 1990s. However, due to the time lag to settlement of claims, this data predates recent attention to awareness and electroencephalographic monitoring, factors that may increase liability for awareness in the future.

Key words: awareness, awake paralysis, closed claims, malpractice, medicolegal liability