Case Archive
Anesthesiology, CRNA
Ref. # 614001

A 44 year old Michigan woman underwent a laparoscopic cholecystectomy. An anesthesiologist and a Certified Registered Nurse Anesthetist (CRNA) were attending. During and soon after induction of anesthesia, the patient received a number of medications, including Kefzol, succinylcholine (a short-acting muscle relaxant for intubation), Pentothal (a barbiturate induction agent), and mivacurium chloride (a short-acting non-depolarizing neuromuscular blocking agent for intra-operative muscle relaxation). Forty minutes later the patient suffered a hypotensive event. Four boluses of neosynephrine were administered during the next forty minutes. One cc of epinephrine was administered during this time, fifteen minutes after the onset of hypotension. The patient's blood pressure became recordable. A medQuest anesthesiologist reported a lack of intra-operative documentation by the anesthesiologist or the CRNA, a breach in the standard of care. This made interpreting the existing records difficult. He opined it was unlikely the hypotension was due to an allergic/anaphylactic reaction to Kefzol, as the attending staff had apparently suspected. Such a reaction takes place within 2-20 minutes of administration of the offending medication. If somehow the reaction resulted from Kefzol, the subsequent treatment was negligent. There was a delay in administering epinephrine, the drug of choice for the treatment of severe allergic/anaphylactic reactions. A medQuest CRNA opined the reversal agents administered were less than required by the standard of care. With proper treatment of the hypotension, the woman would have avoided suffering long-term disabilities.

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