Death on table as an Anesthesiologist

Discussion in 'Anesthesiology' started by doctor712, Jan 4, 2009.

  1. doctor712

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    Hi Gang.

    Hope all are enjoying the weekend as the holiday season tapers off.

    Well, I've shown great interest in Anesthesia because of my shadowing experiences, and also have a great interest in Peds Anesthesia for same reason and life experiences too. As such, I have a question: Is it the norm, can it be expected, that during the course of a (Pediatric) Anesthesiologist's career he/she will lose a patient, a child, on the table? Is this simply a fact of an Anesthesiologist's "typical" career? Of course everyone's replies will be personal and anecdotal, I'm just curious. The second part of the question is not so much whether
    someone will die in my presence - should they be an MVA victim rushed to surgery, or an MI patient that couldn't be resuscitated during a Critical Care rotation - what I'm really getting at is the reality of "causing" or being a major part, in someone's death as an Anesthesiologist during your time as an anesthesia resident, fellow or attending.

    I've come a long way from day one in the OR in NY when I was sort of shocked that patients were paralyzed, ;) , nowadays I am more surprised when they are breathing spontaneously! It's all about learning and perspective and I'd like everyone's; including all those PEDS ANES fellows that would be able to add specific experiences.

    Yes, it's way early for me to think about this, but I did, so I'm asking.

    As usual, thanks,
    D712
     
  2. SleepIsGood

    SleepIsGood Support the ASA !
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    Hey there


    I think it's more the exception than the norm to have a pt die on the table vs somewhere else like the ICU,etc.

    Keep in mind we can pharmacologically keep patients alive typically in the OR.
     
  3. Planktonmd

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    With the current advances in technology and monitoring techniques I would say that it is extremely rare for a patient to die as a direct result of an anesthetic.
    Even in high risk pediatric anesthesia like pediatric cardiac anesthesia or anesthesia on premature infants with all kinds of syndromes it remains extremely rare for the patients to die under the anesthesiologist's care.
    It does happen though and it is horrible but you could practice for 20 years and not witness one death.
     
  4. jwk

    jwk CAA, ASA-PAC Contributor
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    My first cardiac arrest as an EMT was a 4yr old child. I still remember it 33 years later.

    I've probably had 10 or less die on the table in 29 years. Some were major trauma, at least 2 or 3 were big-time saddle PE's (I actually witnessed the post on that one and was very impressed). I would think at most 2 that were unexpected, but both ASA 4 with chronic medical conditions that were not good surgical candidates to begin with.

    I've had more arrest and saves, also usually trauma cases, but the occasional profound bradycardia/asystole due to vagal stimulation also appears on occasion, as well as at least two AFEs.

    Knock on wood, I've never had an arrest because of something I did, but I know those who have (including at least one due to direct negligence) and it is a devastating thing to them.
     
  5. cubs3canes

    cubs3canes Senior Member
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    Sick people die.

    Sick kids die.

    I know that it is tough to think about, but they do die.

    If they come to the OR with a beating heart, we can usually get them to the ICU with a beating heart with enough pharmcologic agents.
     
  6. Planktonmd

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    By the way when I read the title of this thread I thought it was going to address the problem of anesthesiologists dying in the OR.
    I actually heard of such case where the anesthesioogist had an MI and died while providing anesthesia.
    :scared:
     
  7. stone123

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    Haven't had any patients die during my long career practicing anesthesia- coarse i'm no anesthesiologist- just a simple male nurse trained in anesthesia. Did have one of my supervising anesthesiologists choke on some pork in the lounge- we almost lost him. Whew! That was a close one. Did have a few sick folks die under my care during my years working in the ICUs- you sort of get used to those ones droppin' off.
     
  8. huktonfonix

    huktonfonix board certified!
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    If you havent had one either you dont do trauma, transplant, or cardiac or youre just incredibly lucky.
     
  9. doctor712

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    Hi Plankton,

    Yeah, I wasn't very clear with the title. Was looking for something with a hook, but not disrespectful. I am appreciating the replies and would love to hear more takes on experiences...

    Maybe I can up the line of questioning, from not only deaths, to include paralyses via spinals or epidurals? Or major stroke...?

    Couple clarifications on replies:

    big time saddle PEs...guessing means pulmonary emboli?
    AFE: amniotic fluid embolism...?

    Thanks all,
    D712
     
  10. jwk

    jwk CAA, ASA-PAC Contributor
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    correct on both counts - saddle PE refers to a really big clot that gets lodged at the bifurcation of the pulmonary artery.
     
  11. Lonestar

    Lonestar Senior Member
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    i have had two deaths on the table so far. Both were pretty much dead before they got on the OR table. Both ASA 5 and extremly unstable.

    1st one. 78 yr old female with ruptured AAA. s/p two codes. on multiple pressors including epi drip and vitals unstable (BP 70/30).

    2nd one. 39 yr old male s/p GSW to the abdomen and chest. He was shot close range by the homeowner whom he was robbing. Got shot by a shotgun within a range of less than 10ft. Unstable vitals. Thoracic Aorta blown to bits which the surgeon found out later. Liver shot. Other organs looked like mush. Gave 39 units of prbcs, whole bunch of ffp, platelets, etc to no avail. This guy actually looked at me before we put him to sleep and said to me "Doc, don't let me die." To which my attending responded "Don't worry, Jesus loves all."
     
  12. jetproppilot

    jetproppilot Turboprop Driver
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    WOW.

    Thats hardcore.

    Even if the dude deserved it.
     
  13. DET0897

    DET0897 DET
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    4 y/o Trisomy 21, s/p AV canal repair and heart still bad, needs milrinone to live. Kid crashes during first attempt at port placement for home infusion. Barely makes it back to ICU with mil and epi drip and case postponed/no port. Second attempt, crashes, not coming back. PALS measures all the way back to ICU where kid is handed to his dad so that he could die in dad's arms 30 seconds later. I went home and hugged my 2 year old till my hands went numb.

    My advice: if you want to be Peds Anes, dont have kids or it will drive you insane. At least wait to your kids are in their teens.
     
  14. doctor712

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    I already have kids, and they'll pretty much be in their teens when I get to residency/fellowship. Won't stop me from hugging them today a little extra tight after I read your post, that was really sad. P.s. I'll be all about the hugs when they're teens too. :) That is until I get the ol', "Hey dad, shake it out from now on, would ya...?"

    D712
     

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