Closed Claims Case Review Case 2023-05: A Little too Late – A Case from the Crypt

A 50-60-year-old ASA 3 male, with a BMI of 41.3, past medical history significant for coronary artery disease (CAD), post-right coronary artery (RCA) stent placement, obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP), hypertension treated with metoprolol, and hyperlipidemia, was “cleared” by a cardiologist for colonoscopy at an ambulatory center. The anesthesiologist noted the patient's airway was Mallampati 2-3 and a thick neck. Monitored anesthesia care (MAC) was planned. ECG, BP, and pulse oximetry monitoring without end-tidal carbon dioxide (EtCO₂) were applied, and the patient was positioned in the left lateral decubitus position with O₂ administered via nasal prongs at 3-4 L/min. A bolus of propofol 80 mg was administered followed by an additional 20 mg. The patient's SpO₂ fell to 94%, which was managed with a jaw lift maneuver, and the colonoscopy started. The patient's respiratory rate decreased to 6, and SpO...