Expert: Dr Ian Jackson - please note UK based - 3/7/2007

Question
Dr. Jackson:  I appreciate your rapid response.

My attempt to be brief was at the expense of clarity.  The anesthesiologist noted the total care time of "39 minutes" with the endoscopic time at ~ 13 minutes.

The surgeon did not see me in the hospital; at post op office visits, he said he did not know I was admitted.  The anesthesiologist never saw me again.  Therefore, I have to look for answers elsewhere.

The research I have done leaves me with no answers.  Not to predict the future, but, I have not found (learned)what is the risk of anesthesia complications in an endoscopic acromioplasty?

Thank you, again.  Janice
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The text above is a follow-up to ...

-----Question-----
All anesthesia carries risk.  What is the clinical research on risk rate following 11 minutes of anesthesia for an out-patient endoscopic acromioplasty?  An extensive cardiac work up was done on myself, a 54 yo non-smoker, non drinker, non illicit drug use, chronic spinal pain with radiculopathies.  The PACU note reads: "Pt arrived PACU- O2 & oral airway-lungs clear. Pt is weak, pale, dry, and non-responsive and needing resp. assist--chin lift--LMA inserted" "Called anesthesiologist, has started another case"  b.p. widely variable, resp. acidosis on A.B.G., atelectasis on CXR." There was no response to Narcan. LMA was reinserted and "extensive bagging for 20 - 30 minutes." This initiated 3 days in ICU awaiting telemetry admit, various tests:  ECHO, EEG, EKG, CXR, CT Scan Brain, elevated cardiac enzymes of CK-MB & troponin;  then,  utimately,  transfer to another hospital for a cardiac cath via femeral artery (clear), with delerium that evening.  The opinion of the cardiologist after all tests and cardiac cath:  Transient apneic episode following general anesthesia with unresponsiveness; elevated CK MB & troponin, secondary to hypoxemia.  What period of time of anoxia passes prior the spiral downward of several body systems:  ie: respiratory acidosis, increased body temperature, increased glucose, decreased respirations, unresponsiveness, cardiac apnea leading to increased enzymes, brain apnea, inability to insert needles for IV access in extremities.  Four months later I suffer with memory difficulties, flashbacks, multiple difficulties with physiological reactions, and fear of future surgeries or "simple" phlebotomy.  My research & queries do not bring a professional possible answer to set my mind at rest.  I need to know of the percentage of risk in this setting, or the neglect of the anesthesiologist to attend me in PACU, either way, I'm sure I face surgery in my future.  Thank you for your direct answer.  Janice
-----Answer-----
Janice
I suspect from your question that this occurred in the USA. I only start this way as it may be worthwhile asking this question of someone who is based there as I will give an answer based on UK experience. However I will also raise some questions.
It sounds like your cardiologist feels that all the cardiac damage was secondary to a lack of oxygen rather than due to a problem with the blood supply to your heart. If this is the case (and it sounds very likely from your description) then I am not surprised that you are having memory problems. Your brain will have also suffered from the lack of oxygen.
It would be important to know what drugs were used during your anaesthetic and were muscle relaxants used. Muscle relaxants can lead to problems with breathing if they are not reversed adequately and make you appear weak. Narcan would not help in this situation. If you were having problems breathing then this should have been addressed immediately in the PACU. You should have been monitored and this would include pulse oximetry which monitors the oxygen levels in your blood. At no stage should this have been allowed to drop for more than a very short time. To get changes in your blood gases (ABG) with an acidosis implies either you had some severe metabolic problem leading to this (unlikely as they would have told you about it) or it was respiratory in origin - i.e. not enough ventilation (breathing) leads to you retaining carbon dioxide which makes you acidotic. This takes time to reach levels that are dangerous to individuals and so it sounds all a bit funny. Usually we reckon that a patients carbon dioxide will rise about 0.4kPa per minute (sorry UK units) if no breathing is taking place. So it takes a long time for it to increase and make you acidotic. However a fault with the equipment used to ventilate you in theatre could raise it more quickly but again this is monitored routinely and so should not have happened.
I find it hard to believe that you only had 11 minutes of anaesthesia for the operation described as just putting on the special drapes and setting up the equipment would take that long.
In short I do not believe you have the full details of what happened and I feel you deserve a full explanation - have you tried meeting and speaking to the team who looked after you?
I cannot give you a percentage risk on all this for future surgery as I do not know the full details of what happened. I can't help but feel that there could have been something wrong with your care, however I am not aware of all the facts and so cannot say one way or another. Furthermore it would be wrong for me to speculate further on this issue. If you are worried about this I would seek professional help in your country.
I am sorry I cannot be of more help to you about a situation that must have been very stressful to you and your family.
Kind regards
Dr Ian Jackson


Answer
Janice
Given the problems you experienced I find it hard to understand why your anaesthetist did not see you again. The risks of any operation in a young fit patient are low -but problems do happen. The risk of death due to an anaesthetic problem/mistake is quoted as being 1 in 185,000 anaesthetics in the UK.
I suggest you look at the information at http://www.rcoa.ac.uk/index.asp?PageID=673 and http://www.rcoa.ac.uk/docs/death%20or%20brain%20damage.pdf in particular.
I feel you have to get to the bottom of what happened during your hospital stay and this will require speaking to those who looked after you.
Kind regards
Ian