Sleep Apnea Patient Suffers Stroke Following Neck Surgery

Joseph O'Neill

Written by
— Updated on September 22, 2017

Anesthesia Expert WitnessThis case involves a patient in Illinois who suffered complications following neck surgery. A few days before the incident in question, she received an injury to her cervical spine and as a result underwent surgery. The first night following her cervical spine surgery, she was placed in a high dependency unit. There, doctors conducted a neurological exam on the patient. It was noted that the patient had been suffering from severe obstructive sleep apnea and, as a result, the defendant left verbal orders for a continuous positive airway pressure device to be used. Despite these instructions, the patient slept without the machine that night and suffered a stroke. It was also noted that, despite the patient’s presence in a high dependency unit, there was no cardiac monitoring, no oximetry or CO2 monitoring, nursing evaluations, or neurological checks.

Question(s) For Expert Witness

  • 1. Do you have experience treating patients with sleep apnea?
  • 2. What are the proper steps and protocols post opp for a patient on PCA?

Expert Witness Response E-010079

I am the medical director for stroke and, at a second facility, the medical director of stroke and sleep. I am board certified in vascular neurology and double boarded in sleep by the ABSM and ABIM. I frequently treat patients with sleep apnea. I am highly knowledgeable about the proper steps post opp for a patient on positive airway pressure. A dose is set and based on the surgery and pain control required, and the patient is allowed a certain amount of medication through the pump. I have experience monitoring patient control analgesia setups. If the patient develops central or obstructive apneas or desaturations on oxygen, a BiPAP is placed especially in a patient with known severe sleep apnea.

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