[NRSKarenRN]

Interesting discussion. Liked to hear our members thoughts.

How Breast Surgery Killed A Florida Teen

...What we know, so far, is that the 18-year old Florida patient developed the very rare complication of general anesthesia, malignant hyperthermia, literally "dangerous elevated temperature". .

...GA is the predominant choice of anesthesia cosmetic surgery, so her surgeon was within the ‘standard of practice’ in that choice – expedience over outcomes.

Unfortunately, GA or the ‘standard of practice’ includes many unnecessary, avoidable and potentially fatal risks to patients choosing to have surgery that has no medical reason or indication.

Among those avoidable risks are MH, blood clots to the lungs, airway mishaps leading to lack of oxygen to the patient’s brain, postoperative nausea and vomiting (PONV), and postoperative cognitive disorder (POCD).

All of these risks can and should be avoided by having surgeons and patients choose a kinder, gentler anesthetic technique – propofol ketamine or minimally invasive anesthesia (MIA)® pioneered by Friedberg.

Neither propofol nor ketamine are triggering agents for MH. Had Ms. Kubela received MIA, she would likely be alive today. BIS monitoring of the patient’s brain gives a numerical value of propofol sedation at which ketamine can be given without negative side effects...

Teen Dies After Breast Augmentation Surgery - Health News Story ...

[CoolhandHutch]

You quoted a comment to the story...by a 'physician' that redirects you to his own site..

That notwithstanding, I read that this surgery center did not have dantrolene on hand...perhaps someone much smarter than me could explain is this is acceptable practice for a surgery center or not.

[imenid37]

It is terrible this young girl died. at least there appears to have been a reason other than vanity for her breast augmentation. Shame on those parents and surgeons who are letting kids have elective plastic surgery just to enhance their appearance. Look what can happen, even when there is a good reason for the surgery. Poor girl and her family.

[elkpark]

I'm always amazed at how many people assume that having major surgery and general anesthesia is no big deal. My father is a (now retired) anethesiologist, and he drummed into my sister and I from an early age that we should never have general anesthesia unless there was just no other alternative. I find it hard to believe that people are willing to take these kind of risks for cosmetic procedures.

[paindoc]

Inhalational general anesthesia is not typically administered by a surgeon....usually in an office setting, this type of anesthetic involves a CRNA. Non-inhalational anesthetics usually do not trigger MH.
If there was a CRNA, what steps were performed to reduce the damage once recognized ? Was dantrolene administered and if not why not? Why did it take an hour to get the patient to another facility? Lots of questions, lots of responsibility to go round....some of it may extend well beyond the surgeon.
I must disagree with the assertion that the surgery was not medically indicated....cosmetic surgery is just as accepted as any other type of surgery in the US. Medicare pays for botox injections for cosmetic purposes....to argue that cosmetic procedures are medically unnecessary is ludicrous given the widespread acceptance. BIS monitoring has been demonstrated to be extremely inaccurate in propofol administration, therefore it is not indicated. The patient, as young as she was, assumed part of the risks were acceptable including anesthetic risks.

[mammothsnw]

very sad....
the anesthesia provider BTW was an MDA

"The name of the anesthesiologist has not been released, though Schuster's attorney said it was a board-certified medical doctor."

whole story at : http://www.sun-sentinel.com/news/loc...,2477991.story

[ann945n]

I think what is most interesting is why this story got so much news coverage. We all know she is not the first to die from MH. I believe it got media attention because she is a young white girl going in for breast surgery. Had this been a minority male in his 40's no one would have ever heard about it.
My feeling is why is this such a huge story? She signed informed consent for the surgery and was taught about the risk (at least I am assuming they did everything by the book) No surgery is without risk of death. This is not saying I do not feel for the familys loss, but I do feel because of the person being young pretty and white is the only reason we heard about it.

[smileyRn96]

I have 2 thoughts about this case so far....

1) I do not think the autopsy resluts are even back yet. I think ambulance chasers have pushed this case and forced many pressumptions with very little facts made public yet.

2) It appears from what the blood thirsty lawyers have stated that this surgical center failed to have on hand the minimum amount of dantrolene (36 vials). The lawyers state the center either had or admistered only 1 vial.

I feels for this young woman and her family. As someone who begins their CRNA education in August, I feel that this case and the Nevada case (syringe reuse) force me to remember how vigilant I need to be and the standards I must demand of the place I work and of myself.

-Smiley

[wtbcrna]

Originally Posted by NRSKarenRN

Interesting discussion. Liked to hear our members thoughts.

How Breast Surgery Killed A Florida Teen





Teen Dies After Breast Augmentation Surgery - Health News Story ...

No one anesthesia technique is perfect. The one thing I have found from reading different articles so far is that the real problem is the surgery clinic only had one bottle of dantrolene stocked (the treatment for malginant hyperthermia/MH). The recommended stock of dantrolene is 36 vials. Dantrolene only comes in 20mg vials. The dosage range to stop a MH attack is 2.5-10mg/kg+ to start. Assuming that this patient weighed 50kg she would need a bare minimum of 125mg and upwards around 500mg. The clinic only had 20mg on hand!!! My understanding this is done to save a little money with the hopes you can give the patient a small dose of dantrolene and then get them to the nearest hospital...obvisously this is a bad plan and not the recommendation of the MH Association of the US.
http://medical.mhaus.org/index.cfm/f...edicalFAQs.cfm

[icurn011004]

Originally Posted by mammothsnw

very sad....
the anesthesia provider BTW was an MDA

"The name of the anesthesiologist has not been released, though Schuster's attorney said it was a board-certified medical doctor."

whole story at : http://www.sun-sentinel.com/news/loc...,2477991.story

Thanks for the clarification mammothsnw. I'm sure we all want our facts to be kept straight. See you in August.