Hello, this is attorney Oh Seung-hyun of Cheongchul Law Firm.

Many people feel anxious about anaesthesia before surgery or a procedure. Anaesthesia is an essential medical act that allows treatment without pain, yet it also carries the risk of serious complications and death. Where carelessness by the medical team during anaesthesia causes brain damage or death, that may amount to clear medical negligence.

Today, drawing on decisions actually rendered by the courts, we look closely at the types of anaesthesia negligence and how they are judged, how damages are calculated, and what legal steps victims can take.

Types of anaesthesia and the medical team’s duty of care

Main types of anaesthesia

Anaesthesia falls into four broad categories. General anaesthesia, the most powerful, blocks consciousness, sensation and movement, and is used for major surgery. Sedation (intravenous anaesthesia) suppresses consciousness through intravenous agents such as propofol and is widely used for endoscopy and cosmetic procedures. Regional anaesthesia (spinal or epidural) blocks the nerves serving a particular area, and local anaesthesia involves injecting the agent only at the site of the procedure.

Core duties of care for the anaesthesia team

• Before anaesthesia, identify the patient’s underlying conditions, current medication and allergy history, and assess the airway

• Administer the agent at a dose appropriate to the patient’s weight, age and health

• Have an independent clinician continuously monitor oxygen saturation, blood pressure, pulse and respiration during anaesthesia

• Continue monitoring in the recovery room until consciousness is fully regained

• Provide immediate resuscitation, including intubation and CPR, in an emergency

• Before surgery, personally give the patient a sufficient explanation of the risks, complications and alternatives

Principal types of anaesthesia negligence

① Wrong route of administration or intravascular injection

In regional anaesthesia such as an epidural, injecting the agent into a blood vessel can cause fatal outcomes including spinal cord infarction and systemic toxicity. Administering an emergency drug such as epinephrine into the trachea rather than intravenously is likewise serious negligence.

② Failure to assess the airway and failed intubation

Not predicting or assessing airway conditions before general anaesthesia, or careless failure during intubation, can lead to hypoxic brain injury or cardiac arrest. Failed intubation is sometimes unavoidable, but negligence is found where the pre-assessment was neglected.

③ Inadequate monitoring during and after anaesthesia

Sedation with propofol demands the same standard of monitoring as general anaesthesia. Courts hold that “an independent clinician must continuously monitor the depth of anaesthesia together with oxygen saturation, blood pressure, pulse and respiration.” Delegating that monitoring to unqualified staff such as nursing assistants, or leaving the room for a prolonged period, constitutes grave negligence.

④ Delayed emergency treatment

Negligence arises where intubation and CPR are not performed immediately upon respiratory distress, cyanosis or cardiac arrest, or where time is wasted administering an ineffective drug instead of the correct one.

⑤ Joint liability of the operating surgeon and the anaesthetist

Courts hold that “anaesthesia and surgery form a strongly unified single medical act, and the patient expects anaesthesia to be included as a matter of course in the surgical contract.” The operating surgeon has a duty to supervise the anaesthetist as a performance assistant and therefore bears joint liability for anaesthesia negligence as well.

Analysis of key anaesthesia negligence decisions

Intravascular injection during haemorrhoid surgery → complete paraplegia – Daejeon High Court 2020Na12200

A 28-year-old man receiving caudal epidural anaesthesia (lidocaine mixed with epinephrine) for haemorrhoid surgery suffered spinal cord infarction when the agent was injected into a blood vessel, obstructing flow in the anterior spinal artery. No anaesthesia record had been prepared before surgery, which supported an inference of negligence.

On 29 September 2021 the Daejeon High Court found that the operating surgeon had failed to discharge the duty of care in anaesthesia and apportioned 50% liability. The patient suffered permanent complete paraplegia and neurogenic bladder, and the total award was approximately KRW 885.81 million — 50% of lost earnings, treatment and nursing costs, plus KRW 50 million in consolation money. The judgment was affirmed by the Supreme Court.

No airway assessment and failed intubation → cardiac arrest and brain damage – Suwon High Court 2020Na20049

An adult male patient underwent knee arthroscopy. No airway assessment was performed before general anaesthesia to predict difficulty, and a defective tube led to misplaced intubation. Delay and carelessness combined, and cardiac arrest followed.

Holding that cardiac arrest is not a risk incidental to knee arthroscopy, the court ordered full damages without any limitation of liability: approximately KRW 553.11 million to the patient and KRW 5 million to his spouse. Affirmed by the Suwon High Court, the decision clarified the duty to assess the airway before anaesthesia.

21-minute delay and wrong route for epinephrine → death – Seoul High Court 2011Na86845 (affirmed)

During orthognathic (jaw) surgery the patient developed bronchospasm, but the team delayed epinephrine for 21 minutes and administered it into the trachea rather than intravenously. The operating surgeon also failed to cooperate in the emergency response. The patient died about three months after the cardiac arrest caused by the bronchospasm.

The Seoul High Court ordered damages of approximately KRW 131 million to each plaintiff subject to a 40% limitation of liability, and the case was finally affirmed when the Supreme Court dismissed the appeal in 2013Da31144. The decision squarely recognised the duty to administer drugs promptly and accurately in an emergency, together with the operating surgeon’s duty to cooperate.

Ten minutes unmonitored after sedation for minor ankle pin removal → death – Daejeon High Court 2014Na13929 (affirmed)

A healthy 31-year-old man received sedation (lidocaine, fentanyl and propofol) for the minor procedure of ankle pin removal. For ten minutes after propofol was given (10:30–10:40) there was no monitoring at all for respiratory depression, so cardiac arrest went undetected. He had also received no explanation of the risks of sedation or the possibility of death.

On 9 February 2018 the Daejeon High Court ordered damages of approximately KRW 214.57 million to his mother subject to a 50% limitation of liability, affirmed when the Supreme Court dismissed the appeal in 2018Da223245. The decision made clear that “sedation for a minor procedure demands the same standard of monitoring.”

Leaving the operating room five minutes after breast surgery → respiratory failure and death – Seoul Central District Court 2023Ga-Hap88090

A 37-year-old woman underwent breast surgery under sedation lasting about two hours. Only five minutes after the operation ended, the surgeon left the operating room without checking her recovery of consciousness, respiration or vital signs, and delegated monitoring to a nursing assistant who had not completed sedation training. In the emergency the team also wasted time administering Anexate — ineffective against propofol — three times, and the surgeon gave instructions by telephone instead of returning in person.

On 5 November 2025 the Seoul Central District Court found negligence in post-operative monitoring and observation and ordered total damages of approximately KRW 655.97 million: pecuniary loss (including lost earnings of about KRW 594.35 million) multiplied by 80%, or about KRW 555.97 million, plus KRW 100 million in consolation money. It is a recent decision strictly confirming the duty of monitoring during post-operative recovery and by suitably qualified personnel.

Awareness under sedation and burns – Seoul Central District Court 2018Ga-Dan5199307

An adult woman receiving Thermage lifting under sedation became aware and moved; the team failed to control this and continued the laser application, causing second- to third-degree burns to the neck and permanent scarring. No record of the laser application had been kept. The Seoul Central District Court (judgment of 25 November 2020, final) ordered damages of approximately KRW 12.73 million subject to an 80% limitation of liability, recognising the duty to anticipate and respond to awareness under anaesthesia.

Death during propofol sedation for endoscopy – Seoul Central District Court 2014Ga-Hap504606

Where a patient died during propofol sedation for an endoscopy, the court found breach of the duty of independent monitoring of oxygen saturation, blood pressure, pulse and respiration, together with delayed intubation and delayed transfer. Reflecting the inherent risks of propofol, it ordered damages of approximately KRW 308.53 million subject to a 60% limitation of liability.

Calculating damages and rates of limitation of liability

Limitation rates by decision

• No limitation (100%): Suwon High Court 2020Na20049 – no airway assessment and failed intubation; cardiac arrest in knee surgery (not an incidental risk)

• 80%: Daejeon High Court 2014Na13929 – death after ten unmonitored minutes under sedation / Seoul Central District Court 2023Ga-Hap88090 – death after leaving five minutes post-operation / Daegu District Court 2022 – death after early removal of the oxygen mask

• 60%: Seoul Central District Court 2014Ga-Hap504606 – inadequate monitoring during propofol endoscopy

• 50%: Daejeon High Court 2020Na12200 – spinal cord infarction from intravascular injection / Seoul High Court 2011Na86845 – delayed and misrouted epinephrine

Components of the award

Damages for anaesthesia negligence comprise the following.

• Lost earnings: future income lost through death or permanent disability (subject to the liability rate)

• Treatment and nursing costs: medical expenses actually incurred and future care costs

• Consolation money: for the patient (or the deceased) and the bereaved family (awards of KRW 100 million or more have been made in serious fatal cases)

What victims of anaesthesia accidents should do

Step 1. Secure the medical records immediately

Obtain the anaesthesia record (drug type, dose and time of administration), recovery room records, nursing records and vital-sign monitoring records in full. As the decisions show, where no anaesthesia record was prepared at all, courts treat this as a basis for inferring negligence. A hospital’s refusal of a request to inspect or copy records violates the Medical Service Act.

Step 2. Request an autopsy in fatal cases

In a fatal case, request an autopsy (judicial or administrative) to establish the precise cause of death and its causal link to the anaesthesia negligence. Filing a criminal complaint triggers an autopsy by the National Forensic Service automatically. The autopsy result becomes key evidence in both civil and criminal proceedings.

Step 3. Claim against the anaesthetist, the surgeon and the hospital

Even where the negligence is the anaesthetist’s, the operating surgeon and the hospital (its head) bear joint liability. To maximise recovery, bring the damages claim against all three.

Step 4. Mind the limitation periods – three and ten years

A damages claim for medical negligence is extinguished three years from the day the victim learns of the loss and the wrongdoer, and ten years from the day the tort occurred. Consult a lawyer experienced in medical cases as soon as possible after the incident to avoid missing the deadline.

In closing

Anaesthesia accidents are grave instances of medical negligence in which a moment’s carelessness leads to permanent disability or death. Courts demand a strict duty of care at each stage — before, during and after anaesthesia — and substantial liability has been recognised even in comparatively simple procedures such as haemorrhoid surgery, minor operations and endoscopy. It is also the courts’ consistent position that not only the anaesthetist but the operating surgeon and the hospital as a whole bear joint liability.

If you have been harmed by an anaesthesia accident, secure the medical records immediately and consult a lawyer experienced in medical cases. Cheongchul Law Firm maintains a dedicated medical negligence team supporting a wide range of disputes including anaesthesia accidents, surgical negligence and delayed diagnosis. Please feel free to request a free consultation at any time.

Thank you.