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Florida Teen's Cosmetic Surgery Death Explained
Since yesterday, there have been many reports and comments about the Florida teenager who died during breast augmentation surgery. Some report highlights:
While the patient's pre-disposition is hereditary, because of the condition's rarity, few patients can report a family history. Therefore, unless suspected, the condition arises without warning during surgery.
Here are the classical signs of malignant hyperthermia:
In malignant hyperthermia, the muscles are working overtime but not carrying the patient anywhere.
The immediate treatment is well-established. The general anesthestic agent, is "turned off"; 100% oxygen is driven into the lungs. To stop the muscles' hyper-metabolism, a drug, Dantrolene -- specifically used for malignant hyperthermia -- is given intravenously. The body is cooled by packing in ice and the patient is transported to a hospital intensive care unit.
The key to successful treatment and saving the patient's life is early recognition by the surgeon and anesthesia specialist. Because most anesthesiologists have not seen a case in their careers, they must carry a high index of suspicion when the computerized monitors' warning lights and bells suddenly go off for no apparent reason.
Appreciation to Kevin Tehrani, MD, Chief of Anesthesia at the Summit Surgery Center, Beverly Hills, CA., for his input. In preparing this, I consulted with Dr. Tehrani whom I recalled had successfully treated a case of malignant hyperthermia at the USC-LA County Hospital.
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Technorati Tags: florida, teenager, breast enlargement, augmentation, death, malignant hyperthermia
- Malignant hyperthermia, the cause of death, is hereditary and thus any patient undergoing GENERAL anesthesia should be asked: "Family history of problems with anesthesia?" If so, there is a diagnostic test available
- MH, very rare, but reversible if detected early and treated aggressively. Every anesthesia specialist and surgeon should know the management.
- An accredited, licensed or certified surgical facility, whether hospital, outpatient surgery center or office facility is required to have the specific antidote, a drug called Dantrolene, on the premises for emergency use.
While the patient's pre-disposition is hereditary, because of the condition's rarity, few patients can report a family history. Therefore, unless suspected, the condition arises without warning during surgery.
Here are the classical signs of malignant hyperthermia:
- Sudden and otherwise unexplainable RAPID and STEEP rise in the pulse rate, e.g from 80 to 150 within minutes.
- Rapid rise in breathing rate.
- Major temperature elevation, which usually follows the above. Can rise to 106 F or more.
In malignant hyperthermia, the muscles are working overtime but not carrying the patient anywhere.
The immediate treatment is well-established. The general anesthestic agent, is "turned off"; 100% oxygen is driven into the lungs. To stop the muscles' hyper-metabolism, a drug, Dantrolene -- specifically used for malignant hyperthermia -- is given intravenously. The body is cooled by packing in ice and the patient is transported to a hospital intensive care unit.
The key to successful treatment and saving the patient's life is early recognition by the surgeon and anesthesia specialist. Because most anesthesiologists have not seen a case in their careers, they must carry a high index of suspicion when the computerized monitors' warning lights and bells suddenly go off for no apparent reason.
Appreciation to Kevin Tehrani, MD, Chief of Anesthesia at the Summit Surgery Center, Beverly Hills, CA., for his input. In preparing this, I consulted with Dr. Tehrani whom I recalled had successfully treated a case of malignant hyperthermia at the USC-LA County Hospital.
Related Topics:
Technorati Tags: florida, teenager, breast enlargement, augmentation, death, malignant hyperthermia
12 Comments:
Florida teen death: Anesthesia choice likely creates another avoidable tragedy in cosmetic surgery
She wasn’t as famous as Olivia Goldsmith, author of The First Wives Club, but Stephanie Kubela’s death was just as avoidable.
Complications from rare genetic disorder, malignant hyperthermia (MH), appear to be the cause of the Florida teenager’s needless death.
Triggering agents for MH are inhaled general anesthetic (GA) agents (i.e. halothane, desflurane and sevoflurane) and the muscle relaxant, succinycholine (SCH), used to intubate the airway.
GA is the predominant choice of anesthesia cosmetic surgery, so her surgeon was within the ‘standard of practice’ in that choice – expedience over outcomes.
Unfortunately, GA or the ‘standard of practice’ includes many unnecessary, avoidable and potentially fatal risks to patients choosing to have surgery that has no medical reason or indication.
Among those avoidable risks are MH, blood clots to the lungs, airway mishaps leading to lack of oxygen to the patient’s brain, postoperative nausea and vomiting (PONV), and postoperative cognitive disorder (POCD).
All of these risks can and should be avoided by having surgeons and patients choose a kinder, gentler anesthetic technique – propofol ketamine or minimally invasive anesthesia (MIA)® pioneered by Friedberg.
Neither propofol nor ketamine are triggering agents for MH. Had Ms. Kubela received MIA, she would likely be alive today. BIS monitoring of the patient’s brain gives a numerical value of propofol sedation at which ketamine can be given without negative side effects.
In 2005, The Doctors’ Company (TDC) Newsletter extolled the safety of propofol ketamine over general anesthesia for prevention of blood clots to the lungs. TDC is a medical malpractice carrier with a high percentage of plastic surgeons as insured.
No airway mishaps have been reported with MIA. With minimal trespass, patients tend to breathe normally and require little assistance or intervention to keep their airways open. No lack-of-oxygen accidents have been reported with MIA.
MIA has the lowest published rate of PONV, highly desirable, especially for facelift and tummy tuck patients.
Sometimes MIA is called ‘Goldilocks’ anesthesia. BIS monitoring eliminates the common anesthesia practice of giving too much for fear of giving too little. The opportunity for POCD is thereby greatly minimized.
More anesthesia providers are recognizing the advantages of MIA. Both surgeons and anesthesia providers need to be asked to provide it to optimize patient safety for cosmetic surgery.
More information can be found @ www.cosmeticsurgeryanesthesia.com, a patient oriented, non-commercial web site.
Disclaimer: Dr. Friedberg is not employed by Aspect Medical Systems, makers of the BIS monitor. He is not a stockholder or a paid consultant. The opinions expressed herein are his professional opinion based on 11 years experience with BIS monitoring.
Yet another victory for peer pressure, , and lack of self esteem...GoD Bless America, and this victims parents as well..Think Mommy has been under the knife?
I think it wise, to guard pre conceived thoughts about the surgery and the intentions--to the "anonymous" who is quick to judge-did it ever occur to you that the surgery was for reduction or that this individual may have had other health issues relating to large breasts? I have had many acquaintances who had issues of the such and would have done about anything to have been relieved of the pain and discomfort they lived with daily.
Think, before speaking or judging. And what if the shoe was on YOUR foot....wwyd?
Thank you JLB for standing up for a girl who was lost in this tragedy ... I find it rather ignorant for "Annonymous" to be so quick to judge this girl and be so disrespectful to someone who has deceased and their greiving family. We do not know the reasons for this girl having breast augmentation and as JLB said it could have been reduction surgery, there are many serious conditions that can be alleviated by braest reduction.
And I also agree with what JLB said "Think, before speaking or judging."
-KMR
I think this is horrible. I mean a young teen killed by surgery.. Its crazy..
It was in fact a reduction...
I have a family history of Malignant Hyperthermia. It is very scary my brother almost died had the anesthesioligst not noticed the signs right away. Because of this my family has to wear medical tags for the rest of our lives unless we want to go through the muscle byopsy which is extremly painful. This teenager that died is extremly sad there is no way to tell you have it until you have surgery. Just because she went in for cosmetic surgery has no factor on why this happened, she could have died from getting any surgery like a tonsilectomy, or tubes put in her ears. You should not judge people for there choices in life, it's not for you to judge.
If anyone else read the news on this, you would see this was a girl that was born with a deformity in her breasts and wanted it corrected. Absolutely nothing wrong with that. She was at a time in her life that she decided it was a good time to correct it.
Just to clarify a few issues - especially to those who think the surgery MAY have been a REDUCTION:
BREAST AUGMENTATION means to enlarge, taken from the word AUGMENT, which according to Webster's dictionary, is decribed as follows:
AUGMENT: enlarge, increase, raise, expand, broaden, extend.
REDUCTION: from the word "reduce" meaning 'to make or become smaller or less'...
The fact remains that this teenager died during surgery, a tragedy for all involved.
It is also a fact that all surgery carries risk, which is why anyone considering surgery must sign a waiver of indemnity form.
Just the facts, nothing but the facts...
Also Anonymous
It is a shame that this young girl died, but how would her doctors have known about her genetic disorder? Apparently, this was a breast augmentaion, not a reduction. I'm not iformed about any deformmity, but you can't blamer her for wanting to correct that. On the other hand, if she had surgery due to vanity, then it's a sad statement of our society being so caught up in breast size that someone would risk her life as such.
If you are going to rely on "early recognition by the surgeon" to diagnose MH, you are going to be in big trouble. Most surgeons wouldn't have a clue how to diagnose or treat malignant hyperthermia. MH is exceedingly rare, but anesthesia providers are given extensive training in recognizinig and treating this disorder. This statement just further minimizes the incredible work anesthesia providers do every day. Much of the general public doesn't even realize anesthesiologists are doctors too.
As a pediatric anesthesiologist i am quite vigilant about the early recognition of MH. Even with rapid cooling and administration of dantrolene there is still a fair number of fatalities. In a recent issue of Anesthesiology there were a number of cases described where MH was recognized and treated quickly but the patients still did not survive. MH is a rare complication of anesthesia that fortunately is treatable in most cases but fatal in an even smaller number. This case is a tragedy all around and probably a situation where no one did anything wrong but a tragic outcome still occurred. Modern medicine is still not 100% perfect and this must be remembered whenever surgery or anesthesia is required.
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