Interesting Read

One can only speculate about what happened, but it could have been an intravascular injection of the local anesthesia. The epidural space is very vascular and I have personally seen erosion of the epidural catheter into a vein. It also could have been a total spinal anesthetic. Since we weren't there and have information from only the plaintiff's side of the lawsuit, it would be informative to read the medical record and talk with the anesthetist and others involved.

One thing that does bother me--even if there was an intravascular or spinal injection of the anesthetic, it doesn't mean the patient should die. Unless there was a large intravascular injection of marcaine, resuscitation should be sucessful.

It has been a long time since I have done OB anesthesia, so I hope we hear from some practitioners who are more familiar with current practices.

Yoga CRNA

I can see why she died - 12 days to get to a rehab facility! Beyond unacceptable, only the government could get away with it. But I know you mean about the arrest. I don't get it either. She was anoxic for 8 minutes in the OR? Why did it take so long?

Sad story.

I agree with yoga, seems like intravascular injection. Only questions that pop up are 1) was there a test dose administered?, and 2) did the CRNA withdraw before injecting?

This is a really unfortunate story. Is it a common risk for the epidural cath to go into a vascular space? I too am interested.

What a sad story.....also makes me steaming mad.......as one poster put it "Only the goverment can get away with it"........:angryfire

I lived in Hawaii for 5 years ... everyone nicknamed Tripler Army Medical Hospital "Crippler". Unfortunate things happened there all the time.

I wonder if the CRNA chose to use Bupivacaine for the epidural and gave a cardiotoxic dose ???

I received an epidural during the birth of my first child. I was paralyzed for 2 days on my left side. Needless to say, my x-hubby and I were terrified. Then on the 3rd day, the feeling just started coming back slowly. I never have understood fully what happened. It seemed as though that everyone dodged our questions.

single sided epidurals are not unusual if you tend to lay on one side a significantly greater time than another. in the epidural space the fluid will flow with gravity and you can get a greater motor and sensory block on the dependant side.

as for the other case it sounds like an intravascular injection. dont know why airway control took so long as the patient supposedly stated unusual feelings indicating a potential problem.

d

single sided epidurals are not unusual if you tend to lay on one side a significantly greater time than another. in the epidural space the fluid will flow with gravity and you can get a greater motor and sensory block on the dependant side.

thanks...atleast now after 15 yrs i finally have an answer..better than always wondering about it. again..thanks

Very interesting case. On the surface, it does indeed to be an intravascular injection. However, as others have pointed out, a bolus of local anesthetic, in the dose used for epidurals, should not cause toxicity.

The other possibility is a spinal dose, as others have said. A large dose of Marcaine causing a total spinal could have a similiar presentation. However, the time frame cited in the report does not seem consistent with a spinal. It should take longer to set up than the time required to reach S when reciting the alphabet backwards.

Using the alphabet seems strange in itself. Does anyone do this in their practice? I get the pts to notify me if they get lightheaded, tinnitus, restlessness, circumforential lip numbness, etc., but have never seen anyone get a pt to count backwards.

Just finished reading the entire article. What a tragedy...

Very strange why the mother was without O2 for so long, with a nurse anesthetist right there....

Let me start by saying that I have never been stationed at Tripler. I have also had two babies with the military medical system (one premie requiring a four week PICU stay) and have had excellent care. I have also been a civilian labor and delivery nurse at what US New and World Report reported as having the 6th best OB/GYN department in the country for four years from 1996-2000.

These incidents do not only happen at government facilities, I can assure you. A similar incident happened at my previous place of employment (I can say it is a very prestigious hospital in NYC). In the inicident I have first hand knowledge of, the mother and baby died because of what was determine to be a total spinal resulting in respiratory arrest and ultimately cardiac arrest.

I believe the reason you don't hear about those events is two-fold, the high priced legal teams associated with large civilian hospitals and the fact that a story about a government failure makes good press.

I am very saddened that the event happened, but that is an associated risks we have on our consent forms.

We are easy to judge others without the full story (I know I don't have it). You only hope it doesn't happen to you. People early in their practice think it will never happen to them, I hope it doesn't. But, I wouldn't "monday morning quarterback" the situation either. What this situation tells me is that my continual drill of contigency planning I do in the event it happens is worth the effort.

Mike