This case involves a male patient in his thirties who underwent a surgical procedure to correct a herniated disk in his neck in a Pennsylvania hospital. Immediately following surgery, the patient complained of difficulty breathing, throat swelling, as well as difficulty swallowing. It was alleged that the nurses did not deliver all of the complaints to the treating physician. Nevertheless, the treating orthopedic surgeon eventually returned the patient to the OR to explore the source of complaint. The exploration did not yield any abnormal findings, and he was taken back to the post-anesthesia care unit. Shortly after surgery was concluded, the patient started complaining of breathing problems and anxiety. Nurses informed the treating physician, who reported back to the patient’s room just as code blue was called. As a result of his hypoxia, the patient suffered significant brain damage, and eventually died in the hospital as a result of his injuries.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case? Please explain.
- 2. Have you ever had a patient develop the outcome described in the case? If so, please explain.
Expert Witness Response E-001455
Yes, I treat many patients with histories of respiratory issues. I manage their care in the OR and in the PACU post-procedure. I’ve had patients develop/experience breathing issues in the PACU and have managed them successfully. Any patient who presents with such a history following the first procedure must be monitored even more closely after the second. It’s hard to say whether or not she should have been extubated after the second procedure. Many factors are at play in making that decision, including the time of day depending on PACU staffing at “off hours.” I would have to see more information to determine whether or not he met extubation criteria. Twenty years experience as a clinical anesthesiologist in both small and large institutions has provided me with the backgrouned needed to help with such a case.
Expert Witness Response E-008133
This is a devastating result and an interesting timeline. In response to the questions above, yes – I do treat patients like the one described above. I have never had a patient have an anoxic brain injury from hypoxia from such a case. First, it is difficult to dissect care decisions without all available facts. However, this patient seems to have been at high risk for respiratory issues post-operatively and it seems prudent that he be monitored closely and with high acuity in the post-operative period. It is especially concerning given that he was re-explored in the operating room and then re-extubated. I am curious about any timed notes past this event to his worsening status, as well as the discrepancy and potential delay by the covering anesthesiologist / staff in the setting of reintubation. With what is presented, I would certainly be at least quite hesitant and worried about extubating him after the 2nd procedure and her post-op monitoring needs.