to know this, but defence attorneys also value these opinions to help them decide how to proceed. Many cases are not so clear. I review the anesthesiologist’s actions, look at the clinical situation, and consider relevant publications in forming my opinion. Once I have formed an opinion, I discuss it with retaining counsel and let them know the reasons for my opinion. I also tell them how likely it is that other experts could differ in opinion and what those differences may be. As an expert for both plaintiff and defence cases, I am used to thinking about the other side of the argument — especially when the standard of care may be unclear or in flux. More than once, the case settled shortly after I submitted my opinion or report to retaining counsel. Juries and even judges and lawyers do not know enough about the medical considerations to be able to decide the case. Expert witnesses must recognise the issues and explain them in terms simple enough for almost anyone to understand, thus enabling a jury to be able to decide the question of medical malpractice. A strong expert opinion, clearly expressed and well-supported, is gold. What developments have youwitnessed in the field of anesthesiology during your time as amedical practitioner and an expert witness? During my career I have seen numerous changes to improve patient safety and the practice of anesthesia. Some of these changes have come in the form of new medications — notably Exparel and Precedex. Exparel is a long-acting form of Bupivacaine, a local anesthetic, that can be used to help decrease post-operative pain for up to three days. Precedex is amedicine that works on the sympathetic nervous system (fight or flight) to decrease pain and cause mild sedation without significant respiratory depression (excessively slow breathing). These medicines, together with the new emphasis on ‘multi-modal analgesia’ help to control post-operative pain with much less need for narcotic pain medicines. Advances in ultrasound technology and nerve block studies using ultrasound guidance further enhance the practice of multi-modal analgesia by making pain-relieving nerve blocks safer and easier to perform. 72 WWW.LAWYER-MONTHLY.COM | MAR 2022 EXPERT WITNESS Sugammadex is a newer medication that also may enhance patient safety. Sugammadex uses a unique approach to reverse the commonly used muscle relaxant medicines Rocuronium and Vecuronium. Instead of relying on competitive inhibition (see the ‘team musical chairs’ analogy below) to overwhelm the muscle relaxants, Sugammadex binds Rocuronium and Vecuronium, removing them from circulation. This allows much quicker, more complete restoration of muscle strength after muscle relaxation administration. This is potentially lifesaving in a difficult intubation scenario. One other significant advance in anesthesia is the widespread adoption of ‘surgical time-out’, a communication tool which promotes the exchange of important information about the patient, the surgical procedure and anticipated concerns just before beginning the operation. Surgical time-out is intended to help decrease wrong site/side surgery, positioning injuries and burn injuries, and to promote appropriate antibiotic use and patient temperature management. Another key component of surgical time-out is promoting communication and championing the cause of patient
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