Expert: Ronald Levy, M.D. - 4/24/2009

Question
QUESTION: My mom, age 84, broke hip and was having total hip replacement.  Was told she would be having spinal (for numbing) and general (to be put to sleep) anesthesia.  When Duramorph was given via spinal, we were told O2 sats dropped.  She was then intubated and given general anesthesia.   Mom had difficulty waking up.  When we saw her (approx 5 hours after initial spinal), her eyes were open, but she was totally unresponsive.  In ICU she was given phenergan for heaving.  She quit breathing and O2 sats dropped to 60's.  100% oxygen admistered via bipap and vitals returned to normal.  Breathing reps were slow (usually around 9).  Mom returned to consciousness and was able to speak approximately 15 hours after inital spinal.  It has been a week since surgery and her hip therapy is going well.  However, Mom is having short term memory issues and some speech communication issues which were not present before surgery.  Meds prior to surgery include Diovan, Norvasc, Alprazolam & Clonazapam (not taken together), Levothyroxine.  Past med history includes high blood pressure since age 20, enlarged heart due to rheumatic fever as child, anxiety.  Is Duramorph safe for elderly?   Are memory/speech issues permanent or will they get better? Are they a result of the anesthesia or reduced oxygen levels?

ANSWER: Duramorph is safe for the elderly (in the proper dosage) but they are more prone to respiratory depression and most hospitals insist that they go to a monitored bed for 12-24 hrs post surgery for just that reason. As far as the memory problems, these could be related to the stress of surgery and general health issues and "should" resolve. The speech problems are more concerning. You need to make sure she didn't have a stroke (which could also cause the memory problems). The reduced oxygen levels are not a problem if it was for a short period of time (< 3-5 minutes). These problems are not likely due to anesthesia.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: How would I have her checked for stroke?  Shouldn't that have been prior to leaving the hospital?   I've done some reading on reduced O2 and and have read that it can affect short term memory.  I requested mom's medical records today to see if I could ascertain how long she had reduced oxygen levels.  The orthopedic surgeons surgery report indicates reduced O2 sats.  However, the handwritten anesthesia report with O2 sats and other vitals does not.  PACU and CCU vital reports are computer printed.  When I inquired about the printed OR report, I was told it did not exist.  Is this normal protocol?  When the phenergan was given in CCU approx 5-6 hours after Duramorph O2 sats were recorded at 69%. There was a delay in securing the 100% oxygen mask as the regulator would not work properly (I was in the room)and had to be changed out.  When Narcan was given and oxygen secured, sats returned to 98-100. Would sats at 69% for a couple of minutes cause memory problems?

Answer
There may not be a "printed" OR records but there are certainly hand-written nurses notes and an anesthesia record. as for how to get it checked, have her see her primary care physician or a neurologist. I suppose sats of 69% could cause a lot of problems. I am not aware of a specific relationship to memory loss (and none of the explains the speech loss unless she had some kind of anozxic injury to the brain that only a CT will show).

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston