Expert: JM Starkman, MD - 11/14/2009

Question
My granny went in and had a whipple surgery done which lasted 6 hours. Had some complications and she was left open for 2 days , then sewed up . Then they left her under a paralitic drug for 2 more days. My question is. She hasn't woke up after they quit giving her the sleep drugs, (two different types) and it has been 5 days since the drugs have stopped been given to her. All her Ct scans are normal. the dr. doesn't know why she hasn't woke up. Her eyes and motor skills are there. The only thing is that her liver enzemes are up and they think maybe the medicines aren't out of her system yet. What can you tell me about when will a person wake up ?  

Answer
Typical.
You don't mention what "DR." doesn't know what the problem is....and you can bet he's NOT the anesthesiologist.  Granny is elderly and doesn't REQUIRE standard dosages of medications and not enough physicians "dose-down" for the elderly.  Couple that with the fact that the elderly METABOLIZE medicines much slower than younger patients. Add to this the more complex issue of beta vs. alpha elimination of pharmaceuticals (you may wish to look that up if you're really interested) which hardly any non-anesthesiologists ever observe and you 've got a diagnosis:

Overdose.  

Do this:
Insist on the discontinuation of all medications except those needed to control blood pressure and blood sugar. Antibiotics may also be OK but NOT prophylactically---for proven infection ONLY (her liver isn't tolerating all the meds).  Insist on an anesthesia consult---preferably the one who anesthetized her for her whipple procedure--he can review her history more completely to confirm my suspicions.  Make sure her hydration and nutrition status is well addressed.  Stop drawing blood.  Wait--she'll eventually burn off the medicines.

Good luck.