Expert: Ronald Levy, M.D. - 12/20/2009

Question
my brother in law just had surgery on a torn aorta...the replaced a valve and stem ...every time they try to bring him up from being sedated he starts thrashing around..so they put him back under...he has been sedated 2 days and 9 hours.  He is also on a ventilator and can breath extra when the move him or whatever..but is not breathing on his own for the most part.  His temp is now elevated to 100, where yesterday it was normal. His white blood cell count is 13-14K.  They will not be trying to bring him up again until the morning...they have tried several sedation drugs...none of this sounds good to me...it is alread a miracle that he is alive because of the torn aorta. What can be done to get him awake and breathing on his own??? this is urgent. thank you

Answer
Time. You are correct that it is a miracle that he is alive. From what you tell me, he had an ascending aorta rupture which has an extremely high mortality. It is not unusual for someone to be intubated that long, have a fever or a white count. They will continue to wean him from the ventilator and eventually he will wean. It is not plesant to be awake on a ventilator but if he is not ready to have it removed, the docs are between a rock and a hard place, so they sedate him again until he is ready. Be patient.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston