Aspiration on Induction for Orthopedic Surgery

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A 53 year old male was involved in a motor vehicle accident and brought to the hospital with a patellar and acetabular fracture.

He had a medical history of HIV, cardiomyopathy with an EF of 20%, atrial fibrillation, and obesity.

Prior to going to the OR he was evaluated by cardiology service for pre operative clearance.

He was charted to be moderate-high risk with a repeat echo confirming a reduced EF.

He had limited functional status, needing to rest after climbing one flight of stairs.

The day before surgery he was experiencing nausea with several episodes of emesis.

This was thought to be due to pain medicine.

A KUB revealed a bowel gas pattern consistent with an ileus.

In the OR the anesthesiologist attempted to place a pre induction arterial line under 2mg midazolam but was unsuccessful.

The patient was then pre oxygenated.

An RSI was performed with ketamine 50mg, midazolam 3mg, cisatracurium 2mg, and succinylcholine 100mg, followed by an attempt to intubate the trachea with cricoid pressure.

During DL the patient vomited and regurgitated “bilious fluid with fine particles.”

He was turned lateral and suctioned, then back supine and intubated with a Glidescope.

750ml were suctioned total.

Bronchoscopy suction was then performed with minimal aspirated contents seen.

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The oxygen saturation at this point had dipped into the 80s.

The surgery was aborted and the patient brought to the ICU intubated.

That afternoon he was found pulseless.

A code was called but the patient could not be resuscitated and was pronounced dead.

His wife sued the anesthesiologist, orthopedic surgeon, and hospital for the following damages.

The patient’s wife was deposed.

Another family member was an RN, and they both had pre operative concerns regarding his recent vomiting.

The anesthesiologist was deposed and justified proceeding to the OR

He was also asked in depth about why he did not place an NGT, or administer pre meds

Experts were hired for the plaintiff and defense.

Here is the plaintiff’s anesthesiology expert opinion.

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