Jane Smith was admitted for an elective laparoscopic cholecystectomy at an outpatient facility. She received midazolam in preoperative holding, and was brought to the operating room and received propofol and a general inhalational anesthetic. She also received a muscle relaxant and fentanyl. The case appeared to proceed without incident, but in the recovery room, the patient recounted that she felt pain, had difficulty breathing, and was able to recall specific conversations during the procedure. Upon review, it appeared that the syringes for the medications were mislabeled, leading to the medication error and intraoperative recall. A lawsuit was subsequently filed for PTSD and emotional distress.