Should I have made a complaint against this anesthesiologist?

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Whilst on this forum, it was brought back to memory of an incident that happened to me in a very small hospital. I was having cosmetic surgery (which the doctor did not do well enough and we have planned to reschedule for free). Anyway, I'm thinking about asking him the next go around to give me a different anesthesiologist, but before I do I need to know if this is normal. He was doing surgery on my face and I was put under general anesthesia.

I noticed that the anesthesiologist seemed to struggle but then I passed out and obviously don't remember much after that. When I woke she, the anesthesiologist, told me that I was a difficult .....I forgot the medical term... I think it was 'intubate' that she said.

So I went home to recuperate. I noticed that my mouth was severely scratched up, but healed within days I guess because of the high cell turnover in the mouth. Then my throat was so scratched and messed up that I was getting these atrocious shooting pains coming from the throat. I was wondering, what did this anesthesiologist do to me, beat me up whilst I was under! My nose started hurting really bad as if she had broken the septum or something. It sure felt like it.

Then I passed a huge dark reddish blood clot from the nose! Like I've stated, she did say I was difficult and gave me a note about it but I was roughed up badly. I don't think it should have been that way even if I was difficult. What do you think?

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Some people have abnormally shaped anatomical features which makes the usual intubation tricky. I'm not sure how much you know so I'll break it down. When a person goes under general anesthesia, like you did, there comes a point (a few seconds after you black out) that your breathing stops. This is the time the anesthesiologist opens your mouth, sticks this weird looking metal forceps device down your throat (laryngoscope) and kind of forcefully opens up your airway. Then a hollow piece of tubbing (like a thin pipe) is advanced down your throat and well into your airway. This is the part where if you have oddly shaped anatomy that it can be tricky to get this hollow tube into your airway. The anesthesiologist only has several seconds to do all of this because you are NOT breathing by yourself and the anesthesiologist must work quickly doing this in order to put you on a respirator that breathes for you. Anyway, after he or she puts the intubation tube where it's supposed to be, they usually tape it in place outside of your mouth, then they hook it up to a bagging device and they'll usually give you a few oxygenation pumps at this time to make up for lost time, and then they connect it to the respiratory machine, which inflates and deflates your lungs automatically.

The entire process is traumatic to the throat. MANY patients suffer from post-operative sore throats because of this.

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Specializes in Anesthesia.

What your anesthesologist is trying to tell you is that you need to make sure you tell your next anesthesia provider ahead of time that you have a difficult airway. That way the anesthesia provider can prepare the room ahead of time for.... awake fiber optic, glide scope etc. or whatever they decide? You actually would probably be better off getting the exact same anesthesia provider, because they can probably pull your old anesthesia record, will be able to plan ahead of time knowing that you are a difficult intubation, and what worked for them last time.

A lot of times you can't tell someone is difficult intubation until you actually have drifted them off to sleep and are trying to intubate them.

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Specializes in ED, OR, SAF, Corrections.

Both posters above are correct in their assumptions of what probably occured. A sore throat is a common side effect of an EASY intubation, so the fact that yours seemed to have been more uncomfortable than normal corroborates what has been said.

Also, it's an unfortunate occurence that sometimes happens that a patient can even have a front tooth broken during a difficult intubation, (though I've only seen it happen once). Though, the more common things I've seen are small lacerations of the lips and tongue where the laryngescope blade catches on soft tissue or the tissue gets caught against your own teeth - which may have been what happened to you. Once you've been given drugs to knock you out and are no longer breathing on your own, the last thing any Anes/CRNA likes to find out is that you're way more anterior than they anticipated (or have any other anatomical deviation that they've just discovered).

They're not thinking about cuts and abrasions (which they're not being careless in causing) they are just trying desperately to get you some kind of airway support. Also, the fact that you had nasal pain and passed a large clot from your nose (assuming you hadn't been in for nasal surgery) is that she may have at one point tried to intubate you nasally, which is quite common for some types of facial surgery (you don't state your surgery location). But, as the others I'm just guessing since we weren't in the room.

This is another reason I always tell people "There are no simple surgeries". People think what could go wrong in a simple T&A, a little nip or tuck, PE tubes? People die, through NO ONE'S fault in very minor surgeries. Anyone can have a laryngospasm, cardiac arrest from an previously undetected heart problem, even malignant hyperthermia (though rare), anything can happen at anytime to anybody during any case.

I been in the room when an Anes provider counsels the patient on the side effects INCLUDING DEATH and many patients actually giggle for some reason, like the Anes is pulling their leg or something. I really think patients honestly don't believe it.

I also agree with wtbcrna that you'd probably be better off with the same provider as she's already familiar with your anatomy and what she did last time that worked. Best of luck to you and hope things go smoother than last time.

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Both posters above are correct in their assumptions of what probably occured. A sore throat is a common side effect of an EASY intubation, so the fact that yours seemed to have been more uncomfortable than normal corroborates what has been said.

Also, it's an unfortunate occurence that sometimes happens that a patient can even have a front tooth broken during a difficult intubation, (though I've only seen it happen once). Though, the more common things I've seen are small lacerations of the lips and tongue where the laryngescope blade catches on soft tissue or the tissue gets caught against your own teeth - which may have been what happened to you. Once you've been given drugs to knock you out and are no longer breathing on your own, the last thing any Anes/CRNA likes to find out is that you're way more anterior than they anticipated (or have any other anatomical deviation that they've just discovered).

They're not thinking about cuts and abrasions (which they're not being careless in causing) they are just trying desperately to get you some kind of airway support. Also, the fact that you had nasal pain and passed a large clot from your nose (assuming you hadn't been in for nasal surgery) is that she may have at one point tried to intubate you nasally, which is quite common for some types of facial surgery (you don't state your surgery location). But, as the others I'm just guessing since we weren't in the room.

This is another reason I always tell people "There are no simple surgeries". People think what could go wrong in a simple T&A, a little nip or tuck, PE tubes? People die, through NO ONE'S fault in very minor surgeries. Anyone can have a laryngospasm, cardiac arrest from an previously undetected heart problem, even malignant hyperthermia (though rare), anything can happen at anytime to anybody during any case.

I been in the room when an Anes provider counsels the patient on the side effects INCLUDING DEATH and many patients actually giggle for some reason, like the Anes is pulling their leg or something. I really think patients honestly don't believe it.

I also agree with wtbcrna that you'd probably be better off with the same provider as she's already familiar with your anatomy and what she did last time that worked. Best of luck to you and hope things go smoother than last time.

Excellent Post:bow:

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Specializes in CRNA.
Like I've stated, she did say I was difficult and gave me a note about it but I was roughed up badly. I don't think it should have been that way even if I was difficult. What do you think?

I think you should be thankful that the anesthesia provider was able to SECURE AN AIRWAY without having to resort to more extreme measures. That anesthesiologist saved your life. Bad memories are better than no memories at all. Unanticipated difficult airways can be a real hassle for multiple reasons. Many people have no clue as to how potentially dangerous a surgery can be. Especially from an anesthesia standpoint. As WTBCRNA said, make sure you show that letter to the anesthetist when you have your next ELECTIVE cosmetic surgery.

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You had a good doctor. She kept you safe and alive and was smart to pass this info on as it is important for you to know in the future. Many patients have very sore throats after surgery. Totally common. Be sure to let your next doctor know. An elective cosmetic surgery with general is still a serious matter. Whenever you are going under and your airway is involved you want them as prepared as possible. I'd send a thank you note. This doctor is someone you should use again especially as they know your anatomy.

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Specializes in OB, NICU, Nursing Education (academic).

I, too, am a difficult intubation. The above posters are correct. Very common, and it sounds like your doctor was a good one. I actually remember my anesthesiologist asking the nurse for "cricoid pressure".......but that's all. I had a sore throat for several days.

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