Expert: Ronald Levy, M.D. - 12/8/2010

Question
QUESTION: Hi,my dad is a 56 years old with diabetes and high blood pressure. About ten days ago he was hit by a car while crossing the street and broke his right femur and the left femoral neck or head (not sure),any way 5 days ago he had an intramadullary rodding surgery and this morning he was supposed to have his bipolar hip replacement surgery and the thing is after the anesthesia and as they turned him over to start the incision but his heart stopped and they had to revive him with CPR and after that they told us that his glucose level was high about 300. I just want to know what caused that, and is it possible to a high blood pressure patient to undergo general anesthesia and this kind of surgery? and I'm not sure if they measured his blood pressure before surgery, sorry that my question is long but I'm really desperate for an answer and make sure that my dad will be ok.

ANSWER: There are a lot of issues here so let me try to sort some out. Patients with high blood pressure and diabetes certainly can have surgery. We do this all the time. A glucose of 300 is high but is not the reason for the arrest. I am sure they measured his blood pressure before surgery but I'm sure that also had nothing to do with the arrest. Now the question is, "Why did his heart stop". Not seeing the patient or the chart, I can only guess but some possibilities include:
1) When they turned him, they might have dislodged a clot in his leg that embolized to his heart/lung. This is called a pulmonary embolism and I'm sure they have either checked for it or they are going to.
2) After receiving the anesthetic, his blood pressure dropped too low and he had a heart attack.
3) Most likely he just had an arrryhthmia which caused his heart to fibrillate.

There are other possible causes but I am sure his physicians are doing the workup now to figure out what is was so that it doesn't happen again.

Good Luck,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: Hi again, i just knew that the his doctors also said that he had arryhthmia, but they say that they can't operate on him for the hip replacement and they have to wait for 6 months because he had to recover from what happened today, is that necessary cause i'm afraid the waiting will affect the joint fracture repair? (the thing is that I live in Iraq and i just don't trust the doctors here,they feel like they're above people and won't answer any of our questions and concerns or explain the surgery and it's complications,I had to search the information i need online, sorry again for the too long question but i just have to let it all out).

Answer
Generally if someone has had a heart attack, it is recommended to wait 6 months for elective surgery. It sounds like this surgery is not elective but rather urgent (If he remains bedridden because of the fracture, he is at higher risk for Deep vein thrombosis and pulmonary embolism). In this case, the risks of waiting 6 months may outweigh the benefits and he should have the surgery earlier. Since he is having a hip replacement, waiting will not affect the joint repair as they will be replacing the joint altogether. The risk is for development of DVT.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston