Expert: Dr Ian Jackson - please note UK based - 9/17/2008

Question
I had elbow surgery last year, and Fentanyl was used for anesthesia.  That night, my respiratory status almost degraded to arrest.  When the ambulance found me, I was breathing 4-6/min..  My liver had shut down, my kidneys had quit and I had a widened mediastinum that was taken to indicate CHF.  I was inpatient in CCU for 2 weeks on BIPAP since I still wasn't breathing normally, and then on the pulmonary floor for another 2 weeks.  I had to learn how to stand all over again, then, after about another 2 months after the hospital, I could actually walk farther than 600 ft. without becoming winded and without a cane (I was very shaky!)  I was taking Lortab and Percoet PRN for pain, about every 4 hours (not at the same time, alternating), totaling 3 doses.  Could this have caused my condition that put me in the hospital?

Answer
Hi Mitchell
Sorry to hear about what happened to you.
Now this sounds complicated and there are so many variables. Your age, medication you were on preoperatively, duration of surgery, were you given IV fluids, which drugs were used, did you have any preop investigations, were there any problems during surgery etc etc.
It sounds from your story that everything happened very quickly i.e. the same day as your operation. If this is the case then it is unlikely that the pain killers would have caused this problem after only 3 doses. Your liver can be poisoned by an overdose of these drugs but it takes time to happen. By this I mean several days.
So if your liver and kidneys did shut down then then something else must have happened quite acutely. Either you were coming down with serious illness prior to the op and this is all a red herring (seems unlikley) or your body reacted badly to something it was exposed to.
I can see no reason why fentanyl would have been a problem as it only stays in your body for a relatively short time and has an extremely good track record. Also respiratory depression due to opioid overdose does not lead to the acute development of kidney/liver failure. Suspect the respiratory depression was secondary to the effect of your kidney/liver failure.
However all of the above is based on the story given, you do not mention renal dialysis or intensive liver support and so perhaps your kidneys and liver did not fail?
At this point I can't really comment further. This is a discussion that you need to have with those who looked after you. Even with the questions I set answered I would not be able to take this much further without interviewing those who looked after you and looking at your records.
I wish you all the best for the future.
Dr Ian Jackson