Anesthesia and the Science of Medicine

Just this week, a Boca Raton, Florida teen, Stephanie Kuleba, was undergoing a corrective breast surgery. During breast augmentation to correct asymmetrical breasts and an inverted areola, she experienced anesthesia related problems, namely, malignant hyperthermia, a rare condition that can be triggered by certain anesthesia. In layman's terms, hyperthermia is the extreme rising of the body's temperature.

As many plastic surgeries are often conducted in outpatient facilities, when Stephanie's temperature reached 112 degrees, they rushed her to Delray Medical Center. She died 24 hours later. Given the outcome, it is a strange, odd, irony that Stephanie herself wanted to become a plastic surgeon.

To put this in a little bit of perspective, most doctor's become concerned if a patient's temperature reaches 106 degrees and a prolonged temp of that degree can cause brain damage in a short amount of time.

Having spent many years in and out of hospitals and having had roughly several surgeries related to my Crohn's Disease, two lumbar laminectomies resulting from chronic Prednisone use, and working several years as an LPN, I am no stranger to the O.R. and anesthesia.

While doing my clinicals in nursing school, I did a rotation through the O.R. I remember one of the anesthesiologists saying he paid one of the highest medical malpractice premiums, only second to Obstetrics. Not only that, but they have to keep extremely accurate records on their drugs because they are constantly monitored by the medical board.

But a practice most people may not know about is that most anesthesiologists use nurse anesthetists. With my first three surgeries, I remember the anesthesiologist visiting me pre-op in my hospital room to go over allergies and check on my general health. With my last few surgeries, I never saw an anesthesiologist pre-op and a nurse anesthetist was the one administering the anesthesia.

Before my second resection (third Crohn's related surgery) I remember the anesthesiologist coming into my room and checking me out. She was young and seemed quite shy. The next day, when I had my surgery, I remember quite vividly waking up on the operating table. I saw the O.R. light up above and I screamed out in pain. But within seconds, I was back "under."

I told the nurse in Recovery I had woke up on the table. She didn't believe me (though now, after being a nurse, I know it was in the nursing notes in my chart.) When I got back into my room, I told the nurses I had awaken on the operating table. They didn't believe me. I was beginning to doubt if it really had happened.

If I ever had any doubts, they were dismissed the next morning when the anesthesiologist herself appeared in my room. Anesthesiologists never, and I repeat, never come see you after surgery.
She asked me how I was doing and I told her ok, but then I said that I woke up on the table, I saw the O.R. light overhead and I felt the excruciating pain. She assured me that I hadn't awaken, but I could tell by the distressed look on her face that she knew I knew what had really happened.

Luckily for us both, the pain is just a distant memory, as is that moment of shock and fear. Unfortunately for us all, we may be able to pick our general practitioners, our specialists, but you can't pick your anesthesiologists or nurse anesthetists.

Over the next five years, I had two lumbar laminectomies, and in 1994 I suffered from an intestinal blockage due to routine colonoscopy prep. Within days, I was scheduled for another colon resection. This is not an anesthesiology story, but an O.R. in general tale.

With all my surgery and nursing experience, when they wheeled me into the O.R. I was surprised. It was hot. O.R.s are kept cold for a reason. The cold inhibits growth or spread of germs. And when they wheeled me in I made a comment about how hot it was in there. The nurses of course blew me off, telling me it would be ok and they promptly shot me with the pre-op drug to knock me out.

Hours later, I reawaken back in my room to the nurse taking my temperature. Almost immediately after removing the thermometer, she rushed out of the room. Next thing I know, they are hanging antibiotics from my I.V. and reopening my gut right there in my room.

I asked, "What's wrong?"

And the nurse tells me, "You've spiked a temp. You have an infection and we need to reopen the wound, irrigate and then pack it with triple antibiotic gauze."

For the next several weeks I was out of it due to the fever and pain medicine. I endured three times a day repacking of my wound. My gut was open all the way down to my intestinal wall. And after a month, when I was finally released from the hospital, I would still have to pack my open wound with antibiotic soaked gauze until it finally closed up completely.

The truth is we are not all alike. While doctors can only generalize about conditions and treatments and how the majority of folks react to certain drugs and procedures, there are just enough differences in every individual to make medicine not exactly an exact science.

Ask questions, seek referrals, understand the possible complications of any procedure, and learn the Patients Bill of Rights.

TANYA RIVERO and JONANN BRADY Florida Teen Dies After Complications During Breast Surgery ABC news, Good Morning America

Laurie O'Hare, LPN, Associated Content Producer