Expert: Dr Ian Jackson - please note UK based - 1/18/2008

Question
My 82yr. old father was having back surgery for decompression reasons.  He is not "allergic" to narcotics, however he has very little tolerance for them and cannot metabolize them quickly.  After surgery they put him on a morphine pump - (no bolus) just self-induced at a rate of 1mg. every 6 minutes if desired.  He was unable to use the pump so maybe a family member or nurse hit the button for him but i was told very little morphine was administered.  6 days after surgery, he was still 'groggy', he could not feed himself (whereas he was completely normal before surgery).  He has a history of parkinsons dx. and is taking Sinimet.  Ultimately a nurse administered haldol (not sure of the dosage) and he never awoke and passed away 3 days later.  what are your thoughts?

Answer
Hi Adele
This is a difficult one. 82 is elderly to be undergoing surgery and is therefore full of risks. Furthermore for back surgery patients are sometimes put into funny positions that can have an effect on their circulation and often the surgeon requests some lowering of the blood pressure to reduce bleeding. Basically lots going on that may have contributed to your fathers poor recovery. We also have increasing evidence that elderly patients do not do well with anaesthesia - perhaps as high as 1 in 3 having major confusion/mental problems afterwards.
The patient controlled analgesia you describe is quite reasonable but does require the patient to be 'with it' to be able to control it. I am not a fan of family and staff pressing the button because they think he needs analgesia.
I cannot say what influence the haldol had on the eventual outcome and I assume this was given because of severe restlessness and confusion - difficult to see why else a major tranquilliser was given.
So I have gone through the items you mention, I feel that this was a big operation and given his age there was a risk that this would be the outcome.
If you have concerns about this I suggest you meet with his doctors, explain your concerns and ask them do they know why he was so confused postop.
I'm sorry for your loss.
Kind regards
Dr Ian Jackson