This case involves an obese 65-year-old male patient in Texas with a history of obstructive sleep apnea with CPAP treatment, COPD, and hypertension who underwent a hip replacement procedure at a surgical center. In advance of the procedure, the nursing staff instructed the patient not to bring his CPAP machine to the surgical center. The patient’s COPD and sleep apnea were not addressed in the orthopedic surgeon’s pre- or post-operative treatment plan. After the surgery, the patient received hydromorphone and oxycodone by mouth over the course of 12 hours. On the first postoperative day, the patient required oxygen via nasal cannula to maintain oxygen saturation. He continued to receive opiate pain medications without CPAP. The patient was later found by the nursing staff unresponsive and in cardiac arrest. The patient was resuscitated, intubated, and admitted to the ICU. In spite of this emergency response, the patient developed anoxic brain injury and was declared brain dead.
Question(s) For Expert Witness
- 1. How often do you care for postsurgical patients?
- 2. In postoperative patients who have multiple cardiopulmonary comorbidities, what treatment and monitoring measures are generally performed to prevent respiratory depression and hypoxia?
Expert Witness Response E-365761
I care for postoperative/postsurgical patients on a daily basis. I now work as a PACU (postoperative anesthesia care unit) nurse at a large hospital and recover patients with the same multiple cardiopulmonary comorbidities. In all postoperative patients, irregardless of the comorbidities, airway safety is the ultimate priority. I have on array of pain medications that I use alternately to reduce the pain level for the individual patient. I am always monitoring for respiratory depression and hypoxia when administering these medications. If the respiratory rate begins to decrease in the patient shows intermittent apnea, then I will switch to another medication that will not have such an effect on the respiratory rate. In turn, if none of this works then I will call anesthesia and we will review alternatives to reduce the pain level. Patients with comorbidities as this one has may require additional oxygen support such as, BiPAP, CPAP, 100% NRB, etc.