Cardiac Arrest During Sinus Surgery

Editor’s note: This is the first case for paid subscribers. Free subscribers will see a paywall, but it has been placed towards the end of the case so that all readers can still benefit from reviewing the case.

A 29-year-old woman was seen by an ENT surgeon and scheduled for sinus surgery.

She was otherwise healthy.

Dr. S was her anesthesiologist.

General anesthesia was induced but LMA ventilations were challenging.

She was paralyzed with rocuronium and intubated.

Several minutes after the operation began, her blood pressure was undetectable and the pulse ox was not picking up any readings. Her heart rate was in the 70s.

She was given 500mcg of epinephrine.

Repeat blood pressure was 60/40.

All anesthetics were discontinued.

CPR was started and she was given 1mg epinephrine.

The surgery was halted briefly, but apparently the surgeon continued operating again during the code.

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While awaiting EMS, chest compressions continued in a disjointed fashion.

She was given multiple doses of epinephrine and atropine.

Pinky frothy fluid was produced from the ET tube.

EMS eventually arrived and she was taken to a nearby ED.

Despite ongoing attempts at resuscitation in the ED, the patient never had ROSC and was declared dead.

The patient’s husband filed a lawsuit against the anesthesiologist, his employer, and the surgery center.

The expert witness opinion is shown below.

The expert’s report references 4 different sets of documentation, each providing different time stamps and slightly different versions of the events:

• Anesthesia Note

• Anesthesia Record

• Code Blue sheet

• State Department of Health Report

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The defense hired their own expert.

They discussed the theory of anaphylactic shock and a possible airway obstruction.

Their opinion is shown below:

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