code blog: tales of a nurse

I received another story submission. This one came in the form of a letter to a hospital. Although the author included the hospital's name, I have blanked it out here. The author is a patient.

Dear chief of anesthesiology,
I am reporting a "near miss" event at <hospital> outpatient surgery. Facts: I have metastatic prostate cancer. I have cancer in the L3 area of my back.

Last Friday I had surgical repair of right inguinal hernia. I received gas anesthesia and I am recovering---the surgery was successful.
I had a chest x-ray, prior to surgery, which revealed metastatic process in spine. I had pre-surgery physical where I shared my CAT scan and medical information with a medical nurse practitioner.

I was offered spinal anesthesia after discussion regarding history of problems with succynlcholine.
The surgeon was not present when this was discussed with the anesthesiologist but the operating nurse was there.
I questioned the choice while I was on the operating table, before it happened. My spirit guide must have helped me ask this because I had no knowledge it was contraindicated. . I had been premedicated so my cognition was failing when I questioned the procedure.

The anesthesiologist said it would not be a good idea to do this spinal procedure since I had back cancer.
Impression: It was apparent that the anesthesiologist had not read my medical history, nor looked at my x-ray report, before the spinal anesthesia was offered. He was rattled when I told him about my back cancer and seemed upset that he did not know about it. My confidence in the safety of the procedure was impaired and, with my heart attack history, I did not need a catecholamine spike.
The injection of the spinal anesthetic would have been performed if I had not alerted the staff. I had also received a heparin shot less than an hour before the procedure and now I wonder if it is a good idea to give heparin before a spinal?

Conclusion: This is what I call a near miss and I hope you look at where the holes are in the information exchange. I have not been physically harmed and I am not seeking any sort of litigation. I have reported this to JCAH and DOH. I expect to have my other hernias fixed by the same team if appropriate safeguards are in place.
It should be determined why this happened and if it is a pattern or an isolated event.

If there is any doubt regarding the danger of spinal anesthesia and spine cancer please see article: Paraplegia Associated With Combined Spinal-Epidural Anesthesia Caused by Preoperatively Unrecognized Spinal Vertebral Metastasis. by A.Karamaz M.D. Acta Anaesthesiologica Scandinavica - Volume 46 Issue 9 page 1165 October 2002

I don't know the name of my anesthesiologist; my surgeon's name is ...