How Breast Surgery Killed A Florida Teen

Specialties CRNA

Published

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 ...

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.

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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?

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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.

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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.

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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.

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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

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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.

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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.

What world do I live in? A world in which I don't risk my life for cosmetic procedures. But, gee, thanks for straightening me out -- I'll rush right out and schedule that boob job I've been putting off ... :rolleyes:

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Specializes in Anesthesia.
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.

The one site that I saw said it would cost a surgical clinic/hospital and extra 600.00 a yr to stockpile dantrolene. Even double or triple that estimate it is hardly even more than drop in the bucket when compared to the overall surgical operating costs in a moderately busy surgical clinic. There are two things to know about dantrolene: 1. The recommended shelf life is not an accurate reflection of actual product shelf life (it is known from ancetdotal evidence from other countries that the shelf life is actually several years longer), but the manufacture & other companies see no profit margin in doing a study that could potentially increase the shelf-life another two-three years. 2. Dantrolene is still stocked in such small bottles simply because the manufacture sees no profit incentive to increase the size of the bottle. Like all reasearch it doesn't solely fall on the pharmaceutical companies to finance these things.

We are lucky at USUHS to be one of the 5 testing centers for MH in the US, and one of the top research facilities in the US for MH. Some of the medical staff and researchers at USUHS are among the top MH researchers in the world, and they don't think it is unreasonable to stock 36 vials of dantrolene in all hospitals/surgical clinics. Also, with larger patients it can easily take well in excess of 36 vials to treat an MH episode.

MH incidence: 1/15,000 kids; 1/50,000 adults

Increases to 1/5000 with succ & other triggering agents.

I don't think that is that rare when you consider all the surgeries done in the US everyday.

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well to slightly modify your words paindoc

"If there was an MDA, 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? "

What I see that your last post does not expose your bretheren to the same level of scrutiny. Or is it like pain managment being handeled quitetly behind the scenes? ROFL as if the ASA would disipline its own members.

When you and yours subject yourselves to the same withering criticisim that you subject my profession to then you will have some credability. The health care orginization grinding the biggest ax is the AMA with a close second of the ASA.

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Hmmmm....if that is the only cost of Dantrolene, then it makes little sense not to stock it in an ASC. A physicians office, where triggering agents are rarely used with versed/fentanyl sedation or propofol sedation, is not a logical location for the drug. The initial report in the news is that the surgery was performed in a physician's office.

Regarding the appropriate anesthetic for a procedure- anesthesiologists and CRNAs all too often forget the purpose of the anesthetic is not for their comfort or enjoyment...it is for the PATIENT. Open craniotomies do not REQUIRE general anesthesia, therefore the myopic would contend that it is malpractice to administer such. Plastic surgery also does not require GA, but if this is for the comfort of the PATIENT and not that of the technician providing the anesthesia, then it is perfectly acceptable.

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