I just saw an update in the Miami Herald (here) on the events surround the anesthesia related death during breast augmentation of Florida teen Stephanie Kuleba, who underwent a fatal malignant hyperthermia(MH)reaction. This is a case I wrote about in Spring 2008 here & here.

Office based anesthesia is common for many procedures including oral surgery, dentistry, colonoscopies, otolaryngology (ENT), and plastic surgery. There's lots of reviews on this demonstrating outcomes and safety data comparable to hospital operating suites. Most plastic surgery procedures in this setting are on healthier patients, which can make a death more shocking.

Writing back then I said,
"I'm not sure what the take home message from this is. It's such a rare event that it's hard to justify having exotic protocols at all times in low risk procedures. Most office surgery suites maintain a supply of Dantrolene, a medicine to treat MH which is almost $2500 per dose and must be restocked often to stay current. There's plenty of adverse events more common then MH, but we don't have aortic balloon pumps or cardiac bypass machines routinely laying around for that. It already sounds like that the family has hired an attorney who is already assuming an aggressive posture in his comments to the media so I'm sure we'll see some legal proceedings even if perfect care for MH was instituted."

Predictably, the teen's parents in this case are still wanting their pound of flesh and have recently decided to proceed with medical malpractice lawsuits against her surgeon and anesthesiologists despite the Florida Department of Health finding there was no evidence of deviation of standards of care in this tragic event. Does that make any sense to anyone?



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