For all new residents etc. Anesthesia is real simple. We are over analyzing why this obese Texas woman died. We over analyzed why Joan Rivers died.
The endo case in Houston (and New York with Joan Rivers case) all comes full circle to day 1 of basic anesthesia training.....folks. There is a reason why ABCs (or ACB these days with ACLS). But Airway has always been number one factor in life support.
No airway, you got problems, no airway for 10 plus minutes you got big problems.
In the Texas case. Seems to be the patient was without a secure airways for 16-18 minutes? She's 5'2 285 pounds. I am sure mask ventilation wasn't any good considering Sats in the 70s. Yes LMA is alternative. But if patient starts clamping down. A secured ETT tube in a morbidly obese patient is the best option.
What are lessons to be learn? I am going to play devils advocate here. If airway is secure. We have no news story. It's that simple.
I don't think it was patients heart that lead to her death. It was hypoxia. Same with Joan rivers. Of course if you have prolonged hypoxia of course the heart starts that cascade down to where u start calling code
Lesson to be learned:
Look at ASA closed claims cases. Vast majority of closed claims from:
1. Out of OR case. (I think news article was in correct). I highly doubt outpatient egd was done in OR. Had to be endo suite. Joan rivers was outpatient stand a lone endo facility
2. Out of OR cases done WITHOUT ET tube. Aka sedation cases (by Gi docs, cards etc) or by "Mac" anesthesia. We all know Mac is a BS term when it comes to gi these days. It's basically TIVA with propofol.
Don't be cheap. I don't see use of video scope in either of these days. Or documented use of video scope to secure the airway.
If it's truly out of OR. Have a video scope largyscope immediately available. We keep a dedicated one in the GI suite at hospital. Also dedicated videoscopes largyscope up in OB as well. I truly believe if they had video scope largyscope immediately available we wouldn't be talking about it
And I believe it's severely cut down on number of closed claims in the past 10 years.
I would like the asa released updated closed claims study reflecting presence of videoscopes these days.
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Going Under: What Can Happen If Your Anesthesiologist Leaves the Room During an Operation
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