Tragic event, but as usual, news reports raises more questions than answers:
The drugs used in labor epidurals are usually a dilute local anesthetic and a small amount of narcotic. Using both types of drugs in combination allows lower concentrations of each individual drug to be used, hence improving the margin of safety for each. In labor epidurals, our goal is relieve pain without causing significant weakness. That is why we use some local anesthetics over others, at low concentrations, and with narcotics (epidural narcotics relieve pain without paralyzing the patient).This combination is typically infused via the epidural catheter at a rate of 10 to 15 cc/hr. If necessary (i.e. if the patient continues to have pain) we give additional volumes of epidural drug to try to get them comfortable. How much? I’ve given up to 26 cc in an hour.
What’s going on with this patient? I can think of two possibilities: Either the ‘paralysis’ described is from the large amount of local anesthetic she received (in which case it will resolve) or the large volume of anesthetic compromised blood flow to the spinal cord (in which case it may or may not resolve).
But I have other questions as well. Medical errors rarely happen in isolation. There are usually several events that together contribute to the error.
* What time of day was the epidural initiated?
* How busy was the OB floor?
* Was the physician familiar with the equipment? Was it new?
Related posts:
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- Patient satisfaction vs pain relief
- Why primary care doctors shouldn’t be pain specialists
- Treating chronic pain with narcotics and avoiding the risk of addiction
- Should some doctors be restricted from prescribing narcotic pain medications?
- Pain management and contradictory articles
- Coffee overdose?
{ 3 comments }
http://anesthesiamania.blogspot.com/2006/04/sad-trumps-mad-in-this-medical-error.html
Hell, that’s nothing. My pharmacy overdosed my patient by 1000 times, not some wimpy 10 times.
Where is the original article? I can’t find it on this site.
Having performed over 1300 epidurals for labor during the years 1981-1993 I would have to say that it is pretty hard to imagine one dying unless by respiratory failure. This could occur from either the local anesthetic or the narcotic-opioid component.
Aside from these mechanisms it would have to be an inadvertent ’spinal’ or some immediate toxic reaction otherwise unable to be predicted without such a prior history.
Frankly – I can’t imagine killing a patient – via epidural – even if one set about purposely to do it; given that both nurses and doctors normally monitor levels with the feverishness of an obsessive compulsive; which most anesthesiologists have learned to be-in order to survive.
I’d like to see some accurate details in the reporting of this event-skipping the usual hearsay associted with all news reporting.
I’m sure the ASRA would like to see the details also – in order to prevent an event like this from ever happening again.
I was induced into labor, and ended up having an epidural. I was having a really hard time moving because my right leg was absolutely dead to me. I could feel my left leg, I couldn’t feel any contractions or anything. I asked my nurse several times to take me off the drip so I could feel to push and she said that “we leave our patients on the drip” As I progressed, she told me I was fully dialated and to tell her when I felt the baby drop. I never felt anything because I was completely numb. I asked her how I’d even know how to push when it came time and she said “just try and we’ll let you know if you’re doing it or not”. I was really scared since I couldn’t feel my baby. When the nurse came back to check me my baby’s heart rate had dropped and I had to go into emergency surgery. The first thing she asked me is “why didn’t you tell me the baby dropped” I couldn’t feel a thing! My son was born deprived of oxygen and they told us he’d die the first night. He was transfered to UCSF and was put on a cooling blanket for a few days. I have to say that we are truely blessed and he’s a miracle. He’s a healthy 6 month old baby now, but I have to question weather or not the epidural had anything to do with the traumatic birth. Was the baby lodged and not getting enough oxygen because he had dropped into the birth canal and I couldn’t feel him? This is the only thing I can come up with, and I really hated my nurse for ignoring my complaints. I wish they would have listened to me and we could have avoided this. My son’s MRIs are normal, but the specialists say that we will not know if he’s suffered brain damage for years to come, and he will have MRIs in the next few years to monitor him, not to mention he’s got a develope-mental doctor that keeps tabs on him as well as a nurologist that he sees regularly. I can only hope and pray that my son doesn’t ever suffer ceizures like he did, or have any other problems resulting from his birth. Everyone involved in the birth seems to just say, “it’s one of those things that happened, we can’t explain why” I think someone is at fault, and if things were done differently it would not have happened. If I demand medication to be stopped, why didn’t they do it!???
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