Cardiac Arrest After Fistulogram

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A 62-year-old woman with ESRD on hemodialysis was scheduled for a fistulogram.

She had had a previous fistulogram under local, but experienced significant pain.

Therefore her anesthesiologist, Dr. M, proceeded with general anesthesia.

He was present along with Ms. A, CRNA.

A total of 50mg rocuronium IV was given between 14:18-14:19.

Court records noted this was a dose of 0.8mg/kg, implying a weight of 62.5kg.

The CRNAs had switched from Ms. A to Ms. L during the case.

The fistulogram did not reveal any issues, and was completed by 14:44.

The patient was given 2 doses of neostigmine for 4mg total, and a dose of glycopyrrolate.

Following this, sustained tetany was noted on the twitch monitor.

She was extubated at 15:05.

She was reportedly breathing and responding as she was moved to the transport stretcher.

During the trip to the PACU, she was monitored with a finger pulse ox, which did not seem to be working.

On arrival to the PACU, she was noted to be unresponsive and pulseless at 15:12.

CPR was started and she was re-intubated.

After nearly 30 minutes of resuscitation attempts without ROSC, she was declared dead at 15:40.

Her family filed a lawsuit against the anesthesiologist and hospital.

The CRNAs were not named as defendants.

The primary criticisms were that it was negligent to provide general anesthesia, she was given an excessive dose of rocuronium, inadequate neuromuscular blockade reversal, and poor communication between the CRNAs.

The anesthesiology expert witness opinion is shown here:

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