Follow-up question to Dr. Berg: PDA and complications
December 29, 2014 | 100,00 EUR | answered by Dr. med. Ralf Berg
FOLLOW-UP QUESTION COMPLICATIONS PERIDURAL ANESTHESIA
Dear Dr. Berg,
I am back here again; I hope you can assist me again as I have many new pieces of information for you.
Regarding the "medical history":
19:45 The epidural anesthesia was placed back then at L3/4 EDK 4 cm in EDR; (a natural birth was planned)
Dosage: 1000 ml elo-mel, 10 ml Naropin 0.2%, and 10 Sufentanil.
1 1/2 hours later at 21:25, the dosage was increased (for c-section) with 15 ml Naropin 0.75%, 500 Voluven, but NO Sufentanil anymore (elo-mel was unfortunately forgotten).
The times in the records were "altered" by someone afterwards, which means the "correct timeline" looked like this:
On the way to the OR, I felt: palpitations, a sudden state of intoxication, and that something was wrong with my eyes, I could only look straight ahead, I felt so "rigid".
When I arrived at the OR, preparations for the surgery took place between 21:45-21:55.
Around 22:00, the c-section started (I remember this, but I had severe impairment of consciousness). I still heard my daughter's first cry.
ONLY afterwards, around 22:07, I saw a black image in front of me.
This means that the time in the records needs to be shifted about 10-15 minutes earlier (the actual measures and ventilation recorded in the records did not occur until around 22:07).
It is also a fact, even though this is not evident from the records, that I had this black image in front of me from 22:07 onwards, and only came back to consciousness in a completely different room around 2:30.
I know it is noted in the records that I was allegedly transferred back to the delivery room around half past ten, but this actually happened around half past two.
Can anything be identified on the anesthesia machine "Avance" protocol?
Thank you in advance for your response!
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Addendum
As can be seen from the previous post, back then I had a PO2 of 17.8 at 22:03 and a PO2 of 10.7 at 22:24, as well as an O2 Sat of 16.7. As a layperson in the medical field, this sounds very low to me.
Hello,
now the picture is becoming clearer. As suspected, after the decision for a cesarean section, the epidural catheter was "topped up" and at the same time a Voluven infusion was attached to prevent the expected drop in blood pressure. It is okay that unlike the first filling, no sufentanil = strong pain medication from the opiate series was administered. Since with the saturation of Naropin, a spinal anesthesia was intended. With the full dose of Naropin, a complete numbness of the spinal nerves occurred in a PDA, so additional pain medication is no longer necessary.
Indeed, it seems that the PDA had already ascended before reaching the delivery room, which corresponds to the symptoms you described. With such a high spread, the cranial nerves (III, VIII) responsible for eye movement are also paralyzed.
If something like this happens, it is important to deliver the baby as quickly as possible without giving further medications, and immediately switch to general anesthesia to maintain control over breathing.
However, I am still missing the anesthesia protocol. If intubation occurred after 10:07 PM, which is what I would have done in this situation, there should be a protocol about it. When and possibly with what additional medications intubation was performed cannot be seen from the anesthesia monitor.
I would kindly ask you to fax me the protocols to the following number, as I can hardly read them on the monitor 07743 929593. Additionally, I think it would be better if you contact me by phone so that we can shed more light on the matter.
I am particularly interested in what you were told after the procedure. In a course of events like this, a conversation with the responsible anesthesiologist or their senior physician is actually necessary, where everything that happened is discussed.
What I still don't quite understand is where you were transferred after the end of the section, and what happened afterwards.
Please call me at 07743 217 (office) or 0151 50990436 (mobile) with best regards, R.C. Berg
PS: If you are considering legal action, I can only advise you to hire a lawyer who should immediately request access to files or copies of all records.
