Expert: Ronald Levy, M.D. - 4/29/2007

Question
QUESTION: Some years back, I was having a D&C to find out if I was starting into menopause or if there was something else wrong. Shortly after being taken into the operating room, the nurse was beginning to put a shot into my IV and when she began to push the plunger, it broke and the medicine squirted out all over. I could tell the nurse was upset over what had happened. The doctor began doing the D & C and after awhile, I told the nurse that it was really hurting.  She told the doctor what I had said and he told me that he was almost finished.  After he was finished, I was taken to recovery and I told the nurse there that I was okay and just wanted to go back to my room. She didn't believe me, until the next time she checked on me and then she said, "You really are okay, aren't you?" Then, she sent me back to my room where I was released later on.
The shot contained demerol because I knew that it what they were going to give me.  I've often wondered why things turned out the way they did that day. Should the nurse have told the doctor that the shot broke and gotten another one to give me?
ANSWER: I am a little confused because you can't do a D&C on just Demerol. You need either a regional or a general anesthetic. In either case you would not have pain so something is not clear here. Furthermore, if the injection squirted out, the nurse would not need to ask permission, she would just get more of the same drug and give it. So it is hard for me to explain what happened here. If you have more information, I would be happy to try to explain it to you.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

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

QUESTION:  I am taking the MAO Inhibitor, Nardil and when my gyn said he wanted to do the D&C, I told him this and ask him if there would be a problem with the anesthetic and he assured me that there would not be. When the anesthesiologist came in to see me before the procedure and found out I was taking Nardil, he really became upset and he told me that I should have been told to go off of it for three weeks before having this done, which I was not.  He seemed very angry with me and I just wanted to go home after that because I was nervous about having the D&C anyway.  My husband went out and talked to the nurse and then the man came back in and said that they did have something they could give me and it was what they gave to women who were having babies to make them "groggy." My aunt told me it was probably demerol they gave me. I should not have told you that it was demerol without knowing for certain. I was taken into the operating room and my gyn was there and my feet were put up in stirrups and I was all prepared for the procedure before the nurse began to put the shot into my IV, maybe that is important. The rest of the story you know. Having this done was really painful. It felt like my insides were being pulled out  

Answer
It probably was not demerol but it could have been any number of other drugs. In all cases, it was probably inappropriate becuase none of them could give you adequate analgesia (as you discovered). I am sorry that you were cared for in this way. While Nardil does change how we do the anesthetic, we can still do it in a way that is safe and still makes you comfortable. Without looking at the chart I can't say much more but from a cursory view, this was an inadequate anesthetic they gave you.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston