This case takes place in Texas and involves a female patient who was scheduled for gallbladder surgery. The patient was ventilated via a breathing mask, however as the surgery got underway it was noticed that the patient’s blood oxygen levels had began to decrease. Despite the danger posed by a decrease in blood oxygen, there was a significant delay in intubating the patient to ensure adequate air flow. After the surgery, the patient was placed in the intensive care unit, where she was seen by a neurologist who noted what appeared to be a decrease in cognitive function due to hypoxia. It is believed that the patient was not adequately monitored during her gallbladder surgery to ensure that she was receiving an adequate amount of oxygen. She is now permanently injured.
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.
- 3. Do you believe this patient may have had a better outcome if the care rendered had been different?
- 4. Have you ever served as an expert witness on a case similar to the one described above? If so, please explain.
Expert Witness Response E-004510
I routinely do these kinds of cases all the time. I have never had a patient develop this outcome. This is a very strange outcome. Why did the O2 sat drop. The note says there was an analyphylactic reaction, I’d like to know what the reaction was in response to and how this was treated. What was the timeline between the O2 sat dropping and the airway problem being addressed? A CRNA is qualified to intubate patients alone, and it is an accepted standard of care that if the LMA is unstable, a more secure airway be established. I have been an Anesthesiologist for 30 years. I have testified in over 30 cases.
Expert Witness Response E-007934
I routinely provide anesthesia for patients undergoing a variety of prostate surgeries using LMAs. I have not had a patient with a similar outcome. It is likely that this patient might have had a better outcome had the care rendered been different, though I would need to have more information to be certain. It is hard to imagine what happened 8:45 and 10:15 with oxygen saturations this shockingly low. What was the CRNA doing? I did review records on a patient who developed airway obstruction/hypoxia after a cervical spine surgery that may have been related to an allergic reaction/anaphylaxis. I am dual board certified in internal medicine and anesthesiology. I practice in an academic university setting working with CRNAs, residents and medical students. I teach and I directly provide anesthesia in general operating rooms and an ambulatory center. I take care of a variety of patients.