Expert: Ronald Levy, M.D. - 8/23/2009

Question
QUESTION: In Oct 08 I had a simple arthroscopic partial removal of both lateral and medial meniscus.  I asked, several times, both the doctor and the PA and the anesthesiologist NOT to be put under general but have a local or block.  My wishes were not considered and I was put under general.  I have had several surgeries and never have had a problem with anaesthesia but for some reason I did not want it this time.  I woke up back in my room, and felt fine, but I was pretty hopped up on morphine and toradol.  They released me a few hours later.
To make a long story short, the ortho really botched this simple procedure.  The worse part was 10 days after I was still unable to weight bear on the leg and a new symptom developed.  Excruciating pain and a grapefruit sized swelling in my RIGHT thigh.  I went to the ortho, saw the PA and he was more concerned with the now horrendous lymphedema in my left leg, even though I could not sit or put hardly any weight on now my right leg.
I went to my GP who actually examined me and rushed a High Resolution MRI on my right thigh.  I now had a torn hamstring, right off the pelvis.  My current ortho said this bad a tear could only come from trauma. He told me he'd bet anything I had a seizure under anaesthesia. I am a 55 yr old sedate housewife, not an athelete by any means and have been basically bedridden/wheelchair bound since this "minor" surgery.  
He urged me to get my hospital records which I did.  Nowhere is the word seizure used EXCEPT in the Hospital Procedure Related History and Physical.  Under "Review of Systems"  it has CNS: Seizures.  Then there is something written under Neurological that I cannot decipher.  There is NOTHING in the Anesthesia Record or remarks.  Nothing anywhere at all EXCEPT that.  
The drugs used were: Midazolam, Fentanyl, Propofol, Lidocaine and Toradol.  Isn't this supposed to be reported as an "incident" and shouldn't it have been told to my family and myself?  My ortho believes that my hamstring was torn during a seizure.

ANSWER: I hate when doctors ascribe a problem to an area they know nothing about. I doubt you had a seizure as the anesthetics you describe actually have anti-seizure properties. Furthermore, if you did have a seizure, the leg they were operating on was not locked in so it could move freely, so there is no way that could have caused the problem (and if you were seizing, the ortho would have felt it). The anesthesiologist would have documented a seizure (and certainly the nurse in the OR would have) so I am pretty sure that did not happen. More likely the ortho distracted your leg too much (but I am not an ortho so this is also speculation). The CNS in review of systems was from before the surgery (and it was probably a label on the paper, not related to you).

More concerning is your first comment, that your wishes were not considered. They cannot give you a general unless you agree (or it is an emergency).

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: Thank you for your response Dr. Levy.  I am confused about one thing.  Since the Seizure comment was written in on the Procedure Related History and Physical, why would it be there?  I have never had a seizure and it is nowhere in any medical history that I have provided. Next to the HEENT entry it also says I have glaucoma and arthritis, only one of  which I have and that's arthritis.   This hospital and doctor have a VERY poor reputation, which I found out about after the fact.

I to was upset and angry about my wishes not being considered.  From what I'm gathering the doctor does not like his patients awake during his procedures!  Considering I am obese and smoke I was a better candidate for a block, yet they did what they wanted anyway.

Answer
I cannot speak for the medical history and the surgeon wanting an asleep patient does not abrogate your rights. He certainly has the right to not do surgery under blocks but you have the right to a block and may therefore have to seek out another surgeon. No matter what, the anesthesiologist cannot force you to have a general against your wishes, that is considered battery!

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston