Woman in her 30s is left with PTSD after being able to FEEL her surgeon cutting her torso because blundering NHS staff kept her awake and operated on

[TheLoneWolf]

Case out of UK. Makes no sense. Media sensationalized.

Woman in her 30s is left with PTSD after being able to FEEL her surgeon cutting her torso because blundering NHS staff kept her awake and operated on her with the wrong anaesthetic

Woman in her 30s could FEEL surgeon cut her torso open in nightmare op

Yeovil District Hospital (pictured) has accepted responsibility for the event and said a 'communication breakdown' led staff to use the wrong anaesthetic. The patient said medics couldn't hear her scream.

www.google.com

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[vector2]

Case out of UK. Makes no sense. Media sensationalized.

Woman in her 30s is left with PTSD after being able to FEEL her surgeon cutting her torso because blundering NHS staff kept her awake and operated on her with the wrong anaesthetic

Woman in her 30s could FEEL surgeon cut her torso open in nightmare op

Yeovil District Hospital (pictured) has accepted responsibility for the event and said a 'communication breakdown' led staff to use the wrong anaesthetic. The patient said medics couldn't hear her scream.

www.google.com

Makes no sense. Even if I were the layperson writing that article I would be like wtf? The guy writes in the article that a spinal only paralyzes you below the waist but then doesn’t think to ask why the lady wasn’t flailing her arms and torso around in pain....

 

[TheLoneWolf]

Makes no sense. Even if I were the layperson writing that article I would be like wtf? The guy writes in the article that a spinal only paralyzes you below the waist but then doesn’t think to ask why the lady wasn’t flailing her arms and torso around in pain....

Laparoscopic gyn surgery under spinal?

"... although she tried to scream, she claims the oxygen mask and the curtain between her upper and lower body meant none of the staff noticed. "

 

[vector2]

Laparoscopic gyn surgery under spinal?

"... although she tried to scream, she claims the oxygen mask and the curtain between her upper and lower body meant none of the staff noticed. "

Yea I read that, but presumably she could still move her upper half and the anesthetist and the surgery team would be like wtf is going on. Sounds more like she truly didn’t understand what a spinal/MAC was before she was consented. There are large case series of lap surgery using spinal, prop, and analgesics. Insufflation pressure has gotta be kept low tho, like 8-10.

 

[nimbus]

To me it reads like the anesthesiologist gave her a spinal thinking it was an open gyn procedure but then it turned out to be laparoscopic. Still makes no sense why they didn’t just give her a general when they saw it was laparoscopic.

 

[facted]

Didn't read the article but it's my understanding that do lap surgery under spinal in Europe quite frequently.

 

[DirtDocMD]

In my clinical opinion, there’s lots of drama that gets created by folks who think they are somehow making things “simple” trying to avoid putting in an endotracheal tube.

 

[coffeebythelake]

Makes no sense.

 

[deleted697535]

Can you delete this nonsense. Why post it?

Lap surgery under spinal is not common in the UK at least.

 

[TheLoneWolf]

Can you delete this nonsense. Why post it?

Lap surgery under spinal is not common in the UK at least.

Ive only read case reports so I learned that its potentially more common than what I would have guessed is a small handful of possibly academic anesthesiologists. Also, arguing that no one can hear someone wearing a facemask? Calling the staff blundering?

enough weird and as I said sensationalized info to post.

 

[fakin' the funk]

In my clinical opinion, there’s lots of drama that gets created by folks who think they are somehow making things “simple” trying to avoid putting in an endotracheal tube.

Evergreen post

 

[fakin' the funk]

Ah yes, I hate it when the surgeons actually do laparoscopic GYN surgery and I didn't do a general, this ruining my excellent original plan of open GYN surgery under spinal plus zero sedation

 

[chocomorsel]

I stopped reading after the third paragraph. Total waste of time and complete nonsense. Makes no sense whatsoever. Only thing that makes sense is she got a spinal. Complete nonsensical garbage otherwise.

 

[dhb]

Didn't read the article but it's my understanding that do lap surgery under spinal in Europe quite frequently.

Not that i know of...

 

[dannyboy1]

Yea I read that, but presumably she could still move her upper half and the anesthetist and the surgery team would be like wtf is going on. Sounds more like she truly didn’t understand what a spinal/MAC was before she was consented. There are large case series of lap surgery using spinal, prop, and analgesics. Insufflation pressure has gotta be kept low tho, like 8-10.

Why even bother with all this nonsense? Just tube em. Always the best anesthetic plan.....

 

[vector2]

Why even bother with all this nonsense? Just tube em. Always the best anesthetic plan.....

I’m of the same opinion. I think it’s more a European thing

 

[deleted171991]

Daily Mail - Wikipedia

en.wikipedia.org

The Daily Mail is a British daily middle-market[2][3] newspaper published in London in a tabloid format.

'nough said.

 

[deleted171991]

I’m of the same opinion. I think it’s more a European thing

Like suggamadex? Or levosimendan? Etc. Those dumb Europeans.

 

[deleted875186]

Like suggamadex? Or levosimendan? Etc. Those dumb Europeans.

BURN!

....wait your making fun of all of us in the United States ....

 

[periopdoc]

The only thing that makes sense to me is that they did an opiate only intrathecal, followed by a standard ET GA, with a non-depolarizing NMB, but forgot to turn the gas on.

 

[deleted875186]

The only thing that makes sense to me is that they did an opiate only intrathecal, followed by a standard ET GA, with a non-depolarizing NMB, but forgot to turn the gas on.

This plan is even more bizarre than the article.

 

[okayplayer]

The only thing that makes sense to me is that they did an opiate only intrathecal, followed by a standard ET GA, with a non-depolarizing NMB, but forgot to turn the gas on.

Still not sure how that would qualify as "accidentally doing a spinal."

 

[periopdoc]

And once again showing why I dont hang around here much anymore.

Intrathecal morphine, followed by GA, is something that was very common, in private practice, 10 years ago.

It seems to have fallen by the wayside. I suspect insurance companies stopped paying for it.

 

[coffeebythelake]

And once again showing why I dont hang around here much anymore.

Intrathecal morphine, followed by GA, is something that was very common, in private practice, 10 years ago.

It seems to have fallen by the wayside. I suspect insurance companies stopped paying for it.

Is that to take advantage of extra billing? I dont see the benefit of IT morphine + GA vs just GA. Just added risk and time spent on neuraxial for analgesia only..

There are still a bunch of PP places that do these questionable practices, like Ortho surgery with spinal + GA.

 

[periopdoc]

Is it common practice to add morphine to the IT cocktail for c-sections? Why? There's your answer, and no it's not just billing Now we are just arguing over whether the risk outweighs the benefit.

Personally, I think there are way more bizare practices in both private and academic practice, like putting in a spinal, then running a propofol drip, general anesthetic, without airway control, and calling it "sedation," or "MAC."

Disclaimer, I've never done the IT morphine/GA thing because I've never worked in a place where the surgeons demanded it. I do work in a place where spinal/room air general is common, but I have no qualms about doing a spinal, to humor the surgeons, then doing a proper GA, with airway control, if I have any concerns.

 

[okayplayer]

Personally, I think there are way more bizare practices in both private and academic practice, like putting in a spinal, then running a propofol drip, general anesthetic, without airway control, and calling it "sedation," or "MAC."

This is how we do 80%+ of our total hips and knees and I’d say they are probably among the most satisfied patients we take care of when surveyed. Our surgeons also prefer this for a variety of reasons including decreased bleeding, decreased DVT risk (supposedly), etc. Not sure why you consider this to be a bizarre practice.

 

[nimbus]

And once again showing why I dont hang around here much anymore.

Intrathecal morphine, followed by GA, is something that was very common, in private practice, 10 years ago.

It seems to have fallen by the wayside. I suspect insurance companies stopped paying for it.

Yep we did our hearts this way for a number of years.

 

[vector2]

Is it common practice to add morphine to the IT cocktail for c-sections? Why? There's your answer, and no it's not just billing Now we are just arguing over whether the risk outweighs the benefit.

Personally, I think there are way more bizare practices in both private and academic practice, like putting in a spinal, then running a propofol drip, general anesthetic, without airway control, and calling it "sedation," or "MAC."

Disclaimer, I've never done the IT morphine/GA thing because I've never worked in a place where the surgeons demanded it. I do work in a place where spinal/room air general is common, but I have no qualms about doing a spinal, to humor the surgeons, then doing a proper GA, with airway control, if I have any concerns.

If I started doing intrathecal duramorph on a bunch of GETA pts bound for the floor (and with the level of attention floor nurses here give them), I might as well discharge them from the PACU straight to the coroner.

 

[periopdoc]

Bizzare - neuraxial analgesia plus GA, with a secured airway.

Not bizzare - neuraxial block plus GA without airway control, and calling it a MAC or sedation.

¯\_(ツ)_/¯

I'm not saying it's unsafe, nor will result in an unsatisfactory experience. Just that it's a more bizzare departure from historic, safe anesthetic practice than neuraxial analgesia plus GA.

I'm still asking my ortho colleagues, who insist on this recipe, to show me the data. Should they ever take me up on the offer, I will point out that if they ever start seeing the amount of blood loss and, frequency of complications, that the studies consider to be an improvement, they will be wondering why their blood loss and complication numbers have suddenly shot up. (In a good natured way. I'm way less caustic in real life than I am here.)

But, we digress.

Can anyone else provide a different, plausible explanation for this lady's story (other than blaming her for making it up, which would be truly bizzare?)

I'm of the opinion that the anaesthesiologist/ anaesthetist thought it was going to be an open procedure, so administered a IT opiate analgesic before performing a GA with NMB, and simply forgot to turn on the gas.

That would explain her experience, as well as the things she was told afterward. Granted, she is misinterpreting some of the statements.

 

[periopdoc]

If I started doing intrathecal duramorph on a bunch of GETA pts bound for the floor (and with the level of attention floor nurses here give them), I might as well discharge them from the PACU straight to the coroner.

Any data to back up that supposition? How does the rate of respiratory depression compare between IV, IT, and epidurally administered opiates? Do you feel comfortable with your floor patients having IV opiates (either PCA or nurse administered)?

Everywhere I have practiced, all c-sections get IT or epidural morphine, unless they are a elective or crash GA section. They receive far less attention, post-op, than my floor bound patients.

I've never seen or heard of a respiratory event from this practice.

Granted, these aren't post GA patients, and they are significantly healthier than the average surgical patient, and my n may not be significant.

 

[Ronin786]

Large academic center I know of does IT morphine for all their laparoscopic colons and a few other ex-laps. GA for the case and only pulse ox monitoring post-op. No issues with cephalad migration which seems more of a hoax.

 

[dabears505]

One of the options in the eras protocols actually says consider IT opioids. Obviously would need general for a long bowel case in addition, but it's actually not that strange of a practice

 

[coffeebythelake]

One of the options in the eras protocols actually says consider IT opioids. Obviously would need general for a long bowel case in addition, but it's actually not that strange of a practice

Why IT as a single shot and not epidural?

 

[dabears505]

Why IT as a single shot and not epidural?

It's easier. Some podunk small hospitals dont want a running epidural post op, or low incision where motor block not desired. Guess you could run just opioids. Try it once, it's actually nice. I've done it at a locums place where that has been the practice for a long time. Was really skeptical at first, but found it to work really well.

 

[MoMoGesiologist]

Does IT morphine result in less side effects than IV at same levels of analgesia?

For OB, I assumed the low dose IT resulted in less narcotics going to baby when breastfeeding compared to IV so that was the benefit. Otherwise, what’s the overall difference between giving 150mcg IT vs 4mg q4 hours IV?

 

[deleted162650]

Does IT morphine result in less side effects than IV at same levels of analgesia?

If only major textbooks would include tables that outline this exact information. That would be cool wouldn’t it???

 

[deleted171991]

Does IT morphine result in less side effects than IV at same levels of analgesia?

For OB, I assumed the low dose IT resulted in less narcotics going to baby when breastfeeding compared to IV so that was the benefit. Otherwise, what’s the overall difference between giving 150mcg IT vs 4mg q4 hours IV?

Damn intensivist! Who asked you to think?