Postoperative Catastrophes with OSA Patients: Two Sad Accounts
I ended up struggling out of bed, despite the pain, making repeated trips back and forth to the bathroom, just to keep myself awake.
This kind of horror story results from profound ignorance of doctors about sleep, its diseases, and their management. That ignorance is commonplace.
The second case came to my attention as a report from the patient’s family.
This man, also obese, though less so than the first, had a milder case of sleep apnea.
His surgery included a couple of procedures often described as minor. Nevertheless, one of them typically causes a great deal of postoperative pain, requiring narcotic analgesics. This procedure, a uvulopalatopharyngoplasty or UPPP, is often done for sleep apnea despite its notorious lack of effectiveness, and potential for making apnea even worse.
This man made it home from the hospital. He saw his surgeon shortly thereafter. Within a few days, he had died - in his sleep, very soon after his bedtime dose of pain medication.
This man also lacked the benefit of CPAP.
In his case, the surgeon, purporting to treat his sleep apnea as part of the operation, had never tried him on CPAP.
Sometimes it happens that a patient with sleep apnea refuses to try CPAP, and prefers surgery. Maybe, sometimes, this bad decision takes place with a little encouragement from his sleep specialist, who might happen to have his prior specialty training as an otolaryngologist - otherwise known as an Ear Nose & Throat surgeon.
But this time, it was not the patient who made the bad choice; it was the surgeon, acting against the express wishes and expectations of patient and family, to say nothing of a consultant who had given a second opinion against this surgery!
How, you should wonder, can this be? Doesn’t surgery require the informed consent of the patient?
The answer is, Yes - unless the patient is incapable of giving "informed" consent. This might apply, for example, to a patient with Alzheimer’s disease, or one in coma. Or, as in this instance, the patient might be unable to reason about the surgeon’s last-minute change of plans because he had been already sedated in preparation for surgery.(I'll bet you never thought of that way around an individual's consent--or lack thereof!)
But, you should also wonder, doesn’t such a case require the consent of the family?
Yes again - and in this case, the surgeon would
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