Expert: Ronald Levy, M.D. - 10/6/2011

Question
Hi Dr. Levy,
 I had a hip replacement surgery in March, 2011.  I lost 450 ml of blood combined with a low blood pressure for 24 hours hovering in the 80's/50's.  My hematocrit was 24, my hemoglobin 8.  I am 63 years old with arthritis primarily.  My normal blood pressure tends to be on the lower side of normal.  The blood pressure was attended to after 24 hours, and my cardiac output was @110, very uncomfortable.  I saw the blood pressures during surgery, and again there were runs of 20 minutes at a time of 80's/50's.  My oxygen saturation was at times only in the 80's.  I am a veterinarian and we never let the oxygen get that low.  We aim for high 90's at all times.  As a result I suffered partial vision loss in one of my eyes from acute ischemic optic neuropathy as a result of the combination of low bp and anemia.  It is a permanent condition.  I am scheduled for another hip replacement surgery in November, and am so anxious thinking the same thing could happen again!  I had a discussion with the surgeon to use a cell saver which wasn't used the first time and to absolutely monitor my bp carefully, but I have lost faith in the hospital.  I will have an advocate with me this time staying in my room, but I am appalled at the hospital for taking so long to address my low bp.  I had to skip physical therapy the first day due to it and dizziness upon standing.  The surgeon was awesome and I love my new hip but I am panicked about losiing more site in my eyes from  an additional possible shock.  I was given propofol, fentanyl, lidocaine,
demerol, midazolam, odansetron, and succinylcholine along with desflurane and sevoflurane.
Would appreciate your input as I feel like not undergoing surgery again.

Answer
That your blood pressure and sat were so low during surgery is the fault of the anesthesiologist. Obviously without looking at the chart I can't tell why it was so low nor what they did to try to improve it. There is no reason I can think of that would have your sat in the 80's for any length of time and I think that is what the real problem here was. The Hct is not so much of an issue. The low blood pressure should have been treated aggressively. As for the management on the floor, while I won't excuse it, again was probably not the issue here. If you are going back to the same hospital, you need to have a talk with their anesthesia department and make sure they are aware of what happened to you. Assuming you get a qualified anesthesiologist, there is no reason to believe that you will any problems with your next surgery.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston