Twins die within hours - clearly Sleep Apnea?

[SuperGeeky]

The following link describes two twins, both of whom had surgery to remove tonsils. While sleeping that night, both children suffered from cerebral edema and soon after died.

"The official cause of death is listed as cerebral edema. In practical terms, that's fluid on the brain. Doctors testified that the boys, who had a history of snoring and trouble breathing when asleep, simply stopped breathing during the night after the surgeries."

"He said the twins had an underlying, undetected pre-existing condition that prevented them from properly processing the pain medicine and that those complications slowed and stopped their breathing. Leess said he had been told about the mother's concerns about the twins' breathing problems but didn't believe them to be dangerous."

Though, Sleep Apnea is not mentioned in the article, to me it's clearly obvious.... What do you think???

http://www.dispatch.com/live/content/lo ... ml?sid=101


SG

[Julie]

Horrifying. Unimaginable to be them and know it didn't have to be this way. Don't know how they can keep going at all and how they do it without getting arrested for homicide. I'll get arrested if I say any more. Another example of how someone just didn't bother when he had everything needed to do it.

[SuperGeeky]

I think what's so disturbing to me, the Mother told the doctor that the twins snored and had a breathing disorder when they slept. And, during the operation, vitals weren't taken such that the Doctor would know both twins weren't getting enough oxygen???

In this day and age, how could a medical team be that negligent??? How many events such as this go on every day??

Water on the brain from hypoxia?? How does that happen?? Why doesn't the article specify the Sleep Disorder?? This is scary....

[M.D.Hosehead]

Maybe it was simply malpractice on the part of the physician.

Immediately, I suspect money played a role in this tragedy. Perhaps the family were uninsured, or possibly had only Medicaid, and the incentive for both hospital and doctor was to avoid an overnight stay. Or possibly an insurance provider, or an agent thereof, such as a utilization review company, refused to authorize an overnight for a "routine" T&A without complications.

Hospitals and doctors may be tempted discharge patients out too early, because because of reimbursement considerations, and/or because statistics on hospital stays are monitored, and no one wants to fall outside "guidelines". Eventually, skating on thin ice can become the new "normal".

I recall that it took an act of Congress (in the US) to require insurance companies to cover an additional 24 hours for mothers post-partum, after Insurance carriers started to disallow a second night unless there were documented complications.

[chunkyfrog]

Ooooh. Lawsuit!

[NotMuffy]

If not for the time factor, I would have been looking at POPE II:

http://www.aafp.org/afp/20000715/401.html

NotMuffy

[billbolton]

to me it's clearly obvious.... What do you think???

I think you are seeing what you want to see in the press report, which is primarily about the overall issue of negligence rather than specifics.

In terms of hard, clinically relevant evidence, there not enough there to give any solid input to a clinical root cause analysis to the actual mechanism, as there are multiple possible factors/syndromes which could be in play.

Cheers,

Bill

[breakfast]

The cause of death in both children was water on the brain and the article makes it sound as if it was caused by pain meds that they couldn't metabolize properly. Hypoxia was probably the result of the edema, not the cause. These problems can take hours to reach critical levels so there were probably no signs of trouble during their stay in the hospital, especially if the problem was caused by pain medication that they didn't take until they got home.

[Julie]

And that's the whole reason for them to have been kept in at least overnight!

[torontoCPAPguy]

I think that regardless of cause (and I don't have enough data to even make a guess at the cause) what bothers me is the lack of monitoring which is the most basic of post-operative responsibilities. Unexpected? Unexpected? How can it be unexpected except through sheer ignorance? It is totally ignorant to fail to monitor too youngsters post-op and it is strictly a dollars and cents issue. It costs money and manpower to monitor a patient regardless of age.

Hence, I repeat to everyone for their own good... be your own advocate and have an advocate that can act on your behalf if you are incapacitated if you enjoy living. Without my wife, family and friends advocating for me last summer I would most certainly not be here today. The horror stories that I could tell of my experience in hospital for a month would curl your toenails and make your hair fall out in clumps and it was all about dollars and cents. Dollars and cents.

I am here today but for the Grace of God, good family and friends and some very caring nursing staff at the hospital. And THAT is why I take my OSA and health issues upon myself personally in dealing with them. The MD's seem to want to see you in their office for every cough and fart and get you out as soon as possible.

I am so very sorry for the parents and family.... no parent should have to go through that.

[WillSucceed]

BillBolton is right... there is lots more to this than what the press (fear-mongering) has reported. Further, there are tons of different dynamics going on post-surgery that could make a difference and contribute to death.

And, during the operation, vitals weren't taken such that the Doctor would know both twins weren't getting enough oxygen???

During the surgery, the children would be intubated and their O2 and CO2 levels monitored every second. There would be nothing to indicate apnea during the surgery as the tube down the child's throat would physically prevent an obstructive apnea.