Jump to content

How Breast Surgery Killed A Florida Teen

Specializes in Vents, Telemetry, Home Care, Home infusion.

interesting discussion. liked to hear our members thoughts.

[color=#5757a6]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 [color=#006699]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, MSN, RN

Specializes in ER, OR, Cardiac ICU.

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.

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.

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.

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.

ann945n, RN

Specializes in Nursing Ed, Ob/GYN, AD, LTC, Rehab.

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

Specializes in ER/ICU, CCRN, SRNA (class of 2010).

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, MSN, DNP, CRNA

Specializes in Anesthesia.

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/fuseaction/content.display/pagepk/medicalfaqs.cfm

If there was a CRNA, what steps were performed to reduce the damage once recognized ?

So, since is was Dr. Peter Warheit (as stated in several weblinks), are those questions still valid??......... or do they only pertain to CRNAs???

Pedsccrn

Specializes in PER,PICU,Flight,SRNA 2008.

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.

Forgive me if I'm speaking out of turn, as my formal CRNA education won't begin until Fall, however, I don't believe that this well publicized story has anything at all to do with race, or the fact that she was a pretty girl. I believe that the reasons for the grand media attention are:

1) Malignant Hyperthermia is not a subject that is known to the general public, therefore, the tragic death of a young girl from a myopathy that no one has ever heard of IS a big story.

2) Although, I don't believe that race is a factor, I do believe that her age is. The trend is ever increasing for adolescents who are having cosmetic surgery, whether it be breast augmentation, nose jobs, or pinning of those "ears that make me look like a freak!"

3) After all the media attention that was given to the Nevada Surgical Center incident, the public is wary and the media is going to exploit any incidents that involve less than acceptable medical practices. (i.e. one vial of Dantrolene!)

Although, I am greatly saddened for her family and friends, her tragic event may very well deter a few young people from electing to have cosmetic surgery and/or realizing that there are very real risks and hazards involved in surgery and anesthesia. I speak as an informed health care provider, and mother to children who have a family history of MH. You are correct that she most likely gave informed consent for an elective breast surgery and knew the risks and hazards. Did that include incompetence of the medical staff to either recognize and/or to treat her condition? I don't think so..............

:twocents:

Fortunately, the irresponsible and financially impossible recommendations of an association with an axe to grind is not what drives medical care in this country. Prudent and acceptable dantrolene availability is certainly not on-site in every surgery center or doctors office in the US. For such an extremely rare condition, having enough available at one hospital that serves as a repository for dantrolene, should suffice for a moderate sized city.

It appears part of the reason for the press coverage is a pattern of the press jumping to conclusions regarding patient death or injury specifically in the state of Florida, that has been the center of a maelstrom driving states across the US to adopt outpatient anesthesia regulations.

FLTraumaRN

Specializes in Trauma ER and ICU...SRNA now.

CoolHand- It is not standard procedure nor acceptable for a surgical center to perform general anesthesia without the correct amount of dantrolene. I work in a recovery room of a surgical center. We have a MH cart (well, it's more like a tackle box) that is locked and has everything needed for MH initial treatment while transfer to a hospital setting was arranged.

I would be curious to know if anyone else in her family has had a problem with MH and if so did they disclose that to the staff?

unfortunate that you choose an article from a surgeon as your source, as well as including quotes from an anesthesiologist whose main purpose in life is to beat his own drum about "his" anesthesia technique, one that he has trademarked if you can imagine that.

the facts - surgeon-owned asc, an anesthesiologist provided the care (name and picture all over the media), the patient received dantrolene but unsure how much (scumbag attorney that thinks he knows everything says one vial and compares the docs to auto mechanics), and they contacted mhaus for guidance.

other than that, everything is supposition at this point - the medical examiners report hasn't even been released yet. it sounds like she had a whopping case of mh (although there probably is no such thing as a minor case) with all the attending complications including dic. regardless, it's a very sad case, made all the worse by scumbag attorneys and their media whoring. if the clinic in fact did not have enough dantrolene on hand, that will certainly come out, and all involved, from surgeon to anesthesiologist to clinic owners and managers involved with purchasing decisions will be in deep doodoo and writing checks with many 0's.

elkpark - what world do you live in? we do anesthesia for cosmetic procedures by the thousands every day - facelifts, rhinoplasties, otoplasties, breast augs, reductions, and lifts, abdominoplasties and brachioplasties out the wazoo for post-gastric bypass patients, not to mention countless liposuctions for those who need it and those who think they do. (and lets not forget the newest surgical sensation, labiaplasties, but that's another thread). some can be done with local and sedation, some require general anesthesia.

ann945n - your comment is ludicrous as well. the media was all over the death of kanye west's mother just a few months ago. this is not a black or white thing. duh. the reason you heard about it is because of - say it with me - the scumbag attorney. patients die every day from preventable causes or complications from surgery or anesthesia. the only ones that hit the media are cases like this where a scumbag attorney puts it in front of the media and drives a sensational storyline with it.

anggelRN

Specializes in OB.

When you are young, you sometimes forget how fragile life is. I agree with elkpark about avoiding general anesthesia unless there is no other alternative. I personally would never go under the knife unless my life depended on it. It's not worth it. Still, it's sad that she died from this. On a side note, I do not think it is fair to say she only got attention because she was white and pretty. The death of Kanye West's mother caused a lot of media attention as well. She isn't young or white.

jspacegirl

Specializes in SICU.

I'm sure that not everyone watches the show Eli Stone on ABC (I only happen to catch since it's on after Lost and I'm too lazy to change the channel), but there was an episode 2 weeks ago about a young man whose mother died from malignant hyperthermia and he was trying to sue the doctor. Grey's Anatomy had an episode last fall where a patient developed MH as well. I just wonder if portrayals like these on television shows are piquing the public's interest, since I'm sure many people (including newspaper writers) hadn't heard of it before.

Besides the fact that the victim was a young white female, recent public awareness of MH might be the part of the reason why this story is receiving attention.

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion.

Unfortunate that you choose an article from a surgeon as your source, as well as including quotes from an anesthesiologist whose main purpose in life is to beat his own drum about "his" anesthesia technique, one that he has trademarked if you can imagine that.

:D

Wanted to get your :twocents: along with CRNA's spin on discussions

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.

I had cosmetic surgery.

I was a 40DDD. Some may say it was not needed but it was ruining my spine and back.

Dr's predicted by the time I was 50 I would have a hump. I did it for my health.

Guest
This topic is now closed to further replies.
×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK