Sunday, August 7, 2011

Respect Local Anesthesia

Dr. Roberto Bonilla
There is a surfeit of news stories recently about the lethal consequences of local anesthesia. First is the followup to the saga of Dr. Roberto Bonilla. Dr. Bonilla is the Inglewood, CA surgeon who killed his patient while performing a cholecystectomy under local anesthesia (!) in his home converted to a medical office. His lawyer claims that the patient died because of an accidental injection of lidocaine into the patient's blood vessel "which can happen to any doctor." Except hardly any doctor would perform a cholecystectomy using only lidocaine out of a private home even if it is converted to a "medical office". Dr. Bonilla lost his medical license last week.

In Las Vegas a few months ago a patient died during cosmetic surgery due to an allergic reaction to tumescent anesthesia. Ruben Matallana-Galvas and his wife Carmen Torres-Sanchez, neither of whom are licensed to practice medicine, were performing cosmetic surgery from an unlicensed facility when they were giving Elena Caro tumescent anesthesia for a buttocks enhancing procedure. The coroner's office ruled her death accidental due to an adverse reaction though with the large amount of local anesthesia necessary for this procedure who knows if she might not have had an overdose instead. They are being charged with murder though they may plead to the lesser crime of manslaughter.

Finally a five year old Georgia girl died from an overdose of local anesthesia while being treated for a broken arm. Kensley Kirby was taken to the Family Medical Clinic in McDonough by her parents after falling and breaking her arm. Instead of sending her to a hospital's emergency room, the doctors there injected lidocaine to help relieve the pain while setting the arm. They apparently gave too much to the little girl who subsequently died from the procedure.

So many people, not just doctors, think local anesthesia is so safe as to be without consequences. Well there is a reason why injectable lidocaine is not sold over the counter. It can have fatal results in the wrong hands. During anesthesiology residency, we are taught the consequences of intravascular injection of local anesthesia, the maximum dose of local that can be given to a patient, the pharmacodynamics of local anesthesia, the mechanism of action of local anesthesia on nerve impulses and on and on. How many surgeons, internists, or FP's have a complete understanding of the drug? Like any pharmaceutical given to a patient, there are always potential complications. But without a full comprehension of the qualities of locals, the risks for a fatal error are that much greater. So let me repeat this one more time people. Without proper training and monitoring, ANESTHESIA IS NOT EASY. In these unfortunate patients' cases, it was also deadly.

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