The convergent procedure is a epicardial afib ablation done via a subxiphoid approach. A hybrid would be doing the endocardial ablation in the same room before or after the epicardial.
They fail to state when or why the respiratory arrest occurred so it’s hard to judge. Presumably this was done under ga/ett and so it was a failure to adequately secure the airway.
I am almost completely in the dark about the cause of the respiratory arrest. What sort of anesthetic did they use? Was this a sedation case run amok? Was the patient sedated before an anticipated general anesthetic and this happened? Airway FUBAR in planned general anesthetic? Was there a syringe swap and the patient received rocuronium rather than versed as a premed? How in the hades this happened is completely opaque and this case description is useless for education or anything else in its present form.
Too few details to know. If it was a GA case, have to wonder how he got hypoxic. However, did have one strange case of GA for septic LE amp. The guy suddenly got silent w/ mild premeds (fentanyl 1cc, lidocaine IV), so proceeded w/ induction. SpO2 fell, & intubated first attempt w/ VL. SpO2 only improved slowly, much slower than 100% O2 via ET in a usual case. Then a bradycardia. Called code, CPR, epi, etc. & proceeded with/ amputation. ROSC. Awake & talking in PACU. Pt. got a pacemaker post op. Really weird. Don't know if he had a septic embolus or what, but getting his leg off seemed to help turn the tide. If your Pt. is sick, take vigilance up a notch as it may not take much to push them over the edge. Have done more than one "sedation" w/ attempted soothing talk, no drugs, for that reason.
What's the unreasonable time frame? Between pt being induced and procedure start, it's hard to imagine anesthesiologist let unreasonable time pass to not notice development of hypoxia and dropping BP and HR.
Agree. I really don't like it when they put so few details. Their points are not well supported and they don't give an informed reviewer any insight into the case.
The convergent procedure is a epicardial afib ablation done via a subxiphoid approach. A hybrid would be doing the endocardial ablation in the same room before or after the epicardial.
They fail to state when or why the respiratory arrest occurred so it’s hard to judge. Presumably this was done under ga/ett and so it was a failure to adequately secure the airway.
I am almost completely in the dark about the cause of the respiratory arrest. What sort of anesthetic did they use? Was this a sedation case run amok? Was the patient sedated before an anticipated general anesthetic and this happened? Airway FUBAR in planned general anesthetic? Was there a syringe swap and the patient received rocuronium rather than versed as a premed? How in the hades this happened is completely opaque and this case description is useless for education or anything else in its present form.
Too few details to know. If it was a GA case, have to wonder how he got hypoxic. However, did have one strange case of GA for septic LE amp. The guy suddenly got silent w/ mild premeds (fentanyl 1cc, lidocaine IV), so proceeded w/ induction. SpO2 fell, & intubated first attempt w/ VL. SpO2 only improved slowly, much slower than 100% O2 via ET in a usual case. Then a bradycardia. Called code, CPR, epi, etc. & proceeded with/ amputation. ROSC. Awake & talking in PACU. Pt. got a pacemaker post op. Really weird. Don't know if he had a septic embolus or what, but getting his leg off seemed to help turn the tide. If your Pt. is sick, take vigilance up a notch as it may not take much to push them over the edge. Have done more than one "sedation" w/ attempted soothing talk, no drugs, for that reason.
What's the unreasonable time frame? Between pt being induced and procedure start, it's hard to imagine anesthesiologist let unreasonable time pass to not notice development of hypoxia and dropping BP and HR.
Am I the only one who thought the expert witness was sparse on the details?
Agree. I really don't like it when they put so few details. Their points are not well supported and they don't give an informed reviewer any insight into the case.
Totally agree. Kinda bummed there was no details. I was very curious on how/why they came to their conclusions. Any insight?