[Mana_Tangata]

What do you think of a patient who had a resting HR of 43, initial BP of 114/58 (athlete, no cardio probs) who was kept at about 120/60 and a HR of 65-83 for about 2 hours, and had intraoperative recall? The patient informed the surgeon of her low resting HR which caused alarms to go off during a previous procedure, but the surgeon never informed the anesthesiologist. Do you think it was a case of inadequate communication/care, or just bad luck?

[jewelcutt]

The resting heart rate really had nothing to do with recall, the amount of exhaled anesthetic is how we monitor and prevent recall. An increased HR could mean multiple things (I was asked once to state the 17 or more reasons HR increases during anesthesia), but we most likely associate it to a patient having pain or being dry. And we always observe preop vital signs, so I'm sure the anesthesiologist was aware of the increased HR and didn't need to be informed of the baseline by anyone else. Anesthesia is very stressful physiologically to a patient and we try to maintain them pretty steady but it can be difficult to do.

[mwbeah]

Was midazolam (Versed) used preop?

[yoga crna]

There are a lot of reasons for recall, most of which are related to the anesthesia vaporizer being empty or not being turned on. The patient's heart rate may show a response to pain and is one of the many signs an anesthetist uses to regulate the depth of anesthesia.

May I ask what your interest is in the scenerio? My gut feeling is that you are an attorney or work for one and are trying to gather information for a case. If so, this is probably not the best forum to get information. Here, we are interested in the practice of anesthesia and not looking to find fault of an isolated practitioner using limited facts.

Maybe I am off base, if so I apologize. But, it is important that you don't try to make conclusions on limited information and for questionale motives.

Yoga

[Mana_Tangata]

Originally Posted by mwbeah

Was midazolam (Versed) used preop?

No Versed or other pre-op meds. She was on sevoflurane, dilaudid, N2O, rocuronium, pretty typical amounts. Her HR at intake was 66, but probably high due to nerves. It doesn't look like the anesthesiologist was aware of her low hemodynamics.

[Mana_Tangata]

Hi,

I'm the patient, not an attorney. I'm trying to figure out why it happened to me. I didn't want to say that up front because I wanted honest opinions, which I though might be hard for people to give if they knew where I was coming from. I understand that this forum is just folks' individuals opinions.
For those of us that have gone through it, it's really hard to get any answers. Everyone is so afraid of being sued.

Originally Posted by yoga crna

There are a lot of reasons for recall, most of which are related to the anesthesia vaporizer being empty or not being turned on. The patient's heart rate may show a response to pain and is one of the many signs an anesthetist uses to regulate the depth of anesthesia.

May I ask what your interest is in the scenerio? My gut feeling is that you are an attorney or work for one and are trying to gather information for a case. If so, this is probably not the best forum to get information. Here, we are interested in the practice of anesthesia and not looking to find fault of an isolated practitioner using limited facts.

Maybe I am off base, if so I apologize. But, it is important that you don't try to make conclusions on limited information and for questionale motives.

Yoga

[CRNAsoon]

Originally Posted by Mana_Tangata

Hi,

I'm the patient, not an attorney. I'm trying to figure out why it happened to me. I didn't want to say that up front because I wanted honest opinions, which I though might be hard for people to give if they knew where I was coming from. I understand that this forum is just folks' individuals opinions.
For those of us that have gone through it, it's really hard to get any answers. Everyone is so afraid of being sued.

Mana_Tangata,

I hope that you get the answers that you're searching for. Good Luck!

CRNAsoon

[yoga crna]

Mana,
I am sorry that you had recall and hope that you will receive the answers you are seeking.

Recall is very rare in anesthesia, but it does receive a lot of press when it happens because it can be so horrific.

Unfortunately, you will probably never know exactly what happened and trying to analyze the anesthetic record for the answers are going to be futile. For the future, I would be sure to tell the anesthetist of your prior experience and ask for special attention be given to it not happening again. I would give you an amnesic, such as midolazam, plenty of analgesics (depending on the type of surgery) and a lot of hand holding. I don't use a BIS monitor and agree with the majority of anesthesia providers around the world that it is not necessary to prevent or diagnosis recall. I hope you are not a shill for the Aspect Co. who market the device. I am very paranodid these days.

By the way, the anesthesia technique that you listed seem to be appropriate. It is very difficult to judge another person's anesthesia technique, without more information or being there.

Yoga

[gaspassah]

i have stated other peoples first hand opinions of bis since i had never worked with it. however i have started working with it recently and i think it's bunk.
my rationale is, bp went up raise end tidal agent and the bis number went up. lowered the agent after the significant stimulation, bis go down. turn n2o off ad add air bis go down. seems i get the inverse ratio for some reason, and i didnt have it on backward either. i have worked with some quality crnas and monitoring vs and pupils still work. i think bis not being reliable could lead ppl to give too little anesthetic and cause awareness also.
just my .02
d

[Mana_Tangata]

Originally Posted by yoga crna

Mana,
I am sorry that you had recall and hope that you will receive the answers you are seeking.

Recall is very rare in anesthesia, but it does receive a lot of press when it happens because it can be so horrific.

Unfortunately, you will probably never know exactly what happened and trying to analyze the anesthetic record for the answers are going to be futile. For the future, I would be sure to tell the anesthetist of your prior experience and ask for special attention be given to it not happening again. I would give you an amnesic, such as midolazam, plenty of analgesics (depending on the type of surgery) and a lot of hand holding. I don't use a BIS monitor and agree with the majority of anesthesia providers around the world that it is not necessary to prevent or diagnosis recall. I hope you are not a shill for the Aspect Co. who market the device. I am very paranodid these days.

By the way, the anesthesia technique that you listed seem to be appropriate. It is very difficult to judge another person's anesthesia technique, without more information or being there.

Yoga

I am not an attorney or a shill for Aspect. I'm not sure that I want to get this discussion, but the first thing my anesthesiologist said regarding the incident was that a BIS monitor would not have helped me. While I've been doing research I've come across an amazing animosity towards Aspect, it seems like they have really ****** people off. As a patient, I have to say that I don't really care.

I agree that I probably won't find answers in my anesthesia record. I have to say for all of you out there, though, that it matters. When I looked at mine and saw that my anesthesiologist had converted my weight from lbs to kgs wrong, transcribed my temperature at intake wrong, gotten the medications that I was currently on wrong, as well as the date/time wrong, it was pretty depressing. For all I know he gave me the best of care possible, maybe something he did saved my life, but when I see all the mistakes on my record it makes me feel like I was as important as a hamburger patty at McDonald's.