Post-Spinal Surgery Complications: Cardiac Arrest and Coma

Two days after spinal surgery, the patient experienced cardiac arrest and became comatose?

I have a relative who sustained a spinal cord injury due to a crush injury on August 17.
On August 22, he underwent surgery to replace an artificial bone joint and was transferred to a general ward for recovery, where everything seemed normal.
On August 24, around 1:30 PM, after the nurse removed the subcutaneous drainage tube from the surgical site, the patient experienced a rapid heartbeat, which soon led to cardiac arrest and unconsciousness.
After resuscitation efforts, he was transferred to the cardiology intensive care unit around 4 PM.
When family visitation was allowed at around 9 PM, he remained in a comatose state.
On August 25, during a visit at 8 PM, he was still in a comatose state but exhibited eye-opening.
On August 26, during a visit at 8 PM, he remained comatose but showed tearing and slight movement in his hands.
By August 27, he was completely unresponsive, and the physician indicated a Glasgow Coma Scale score of 3 with an unknown cause and no signs of myocardial infarction.
His current condition is not suitable for neurosurgery, and it has now been over 14 days with no improvement.
His heart rate is approximately 65, he is on a ventilator, and his renal function is poor, requiring dialysis every 2-3 days.
The patient had no abnormalities in blood pressure during routine health checks, and aside from the spinal cord injury, there were minor hemorrhagic signs in the eye and face on the day of the injury, possibly due to excessive straining during an escape attempt.
What could have caused the rapid heartbeat and abnormal cardiac arrest two days post-surgery? Why did it take nearly 40 minutes of resuscitation to restore his heartbeat? Could cerebral hypoxia lead to a hematoma? How long does hypoxia need to occur to cause this? Is there a connection between the cardiac abnormalities and the spinal surgery? Is there a relationship with the removal of the subcutaneous drainage tube? Could this be an anesthetic complication, or are there other possibilities?

jansy, 50~59 year old female. Ask Date: 2011/09/08

Dr. Ding Xianwei reply Neurosurgery

Due to incomplete information, the question you asked may not receive the assistance you need.
Rapid heartbeat leading to cessation may also be caused by cardiac issues.
Therefore, we may not be able to provide the assistance you require.

Reply Date: 2011/09/08

More Info

The situation you've described regarding your relative's post-spinal surgery complications is indeed complex and concerning. Let's break down the potential causes and implications of the cardiac arrest and coma following the surgery.

Possible Causes of Cardiac Arrest and Coma
1. Anesthesia Complications: General anesthesia can lead to various complications, including cardiovascular instability. Certain anesthetic agents can cause hypotension (low blood pressure), bradycardia (slow heart rate), or even cardiac arrest in susceptible individuals. If your relative had pre-existing heart conditions, these risks could be heightened.

2. Fluid and Electrolyte Imbalance: Post-surgical patients are at risk for fluid and electrolyte imbalances, especially if there was significant blood loss during surgery or if the patient was not adequately hydrated. Such imbalances can lead to arrhythmias (irregular heartbeats) and potentially cardiac arrest.

3. Hypoxia: If the patient experienced a drop in oxygen levels (hypoxia) during or after surgery, this could lead to brain injury and loss of consciousness. Hypoxia can occur due to respiratory complications, such as airway obstruction or inadequate ventilation, particularly in the immediate postoperative period.

4. Cardiac Events: The stress of surgery, combined with any underlying cardiovascular issues, could lead to a myocardial infarction (heart attack) or other cardiac events. Although you mentioned that there were no signs of myocardial infarction, it’s important to consider that cardiac events can sometimes present atypically.

5. Neurological Factors: The spinal surgery itself may have affected the autonomic nervous system, which controls heart rate and blood pressure. Additionally, if there was any manipulation of the spinal cord or surrounding structures, this could potentially lead to autonomic dysregulation.

6. Postoperative Complications: The removal of the subcutaneous drainage tube could have led to changes in the surgical site, possibly causing bleeding or hematoma formation, which might contribute to increased intracranial pressure if the bleeding was significant.

Why Did It Take 40 Minutes to Restore Heartbeat?
The duration of resuscitation efforts can vary widely based on the underlying cause of the cardiac arrest, the effectiveness of the interventions, and the patient's overall health status. In some cases, if the heart is not responding to initial resuscitation attempts, it may take longer to restore a stable rhythm. The brain can begin to suffer irreversible damage after approximately 4-6 minutes of severe hypoxia, which is critical to consider in this case.

Brain Hypoxia and Potential Complications
Brain hypoxia can indeed lead to serious complications, including brain edema (swelling) and possibly a hematoma (localized bleeding outside of blood vessels). The duration and severity of hypoxia are critical factors; prolonged hypoxia can lead to significant neurological deficits or even brain death.

Relationship Between Cardiac Issues and Spinal Surgery
While cardiac issues are not directly caused by spinal surgery, the stress of the surgery, the effects of anesthesia, and any complications that arise can certainly contribute to cardiac instability. The removal of the drainage tube might not have a direct correlation with the cardiac event, but it could be part of a series of postoperative changes that led to the patient's decline.

Conclusion
In summary, the cardiac arrest and subsequent coma following spinal surgery could be attributed to a combination of anesthesia complications, fluid imbalances, hypoxia, and potential neurological factors. It is crucial for the medical team to continue monitoring and assessing the patient’s condition, as well as to conduct further investigations to determine the exact cause of these complications. If there are ongoing concerns, seeking a second opinion from a neurologist or a cardiologist may provide additional insights into the patient's condition and potential treatment options.

Similar Q&A

Understanding Anesthesia Concerns for Spinal Fusion Surgery

Scheduled for December 9, I will undergo internal fixation lumbar spinal fusion surgery due to L5-S1 vertebral fracture complicated by nerve traction. The anesthesia method will be GA-TUBE. I would like to ask a few questions. During my last knee arthroscopy, I also received gene...

Dr. Lin Xiuying reply Anesthesiology
Hello: First, I would like to know if you are an athlete. Athletes can experience "bradycardia" (a heart rate of less than 60 beats per minute). However, if the heart rate drops below 30 beats per minute, it is still necessary to have a cardiologist confirm the physiolo...

Post-Operative Complications After Spinal Cavity Surgery

I have a family member who just underwent spinal cavity surgery, and it's been about a week since the procedure, but they are still experiencing headaches. Is this symptom still within the postoperative recovery period? Additionally, what other symptoms might occur after the...

Dr. Wang Shouji reply Orthopedics
Hello, this is a neurosurgery issue. Changhua Hospital cares about your health. Wang Shou-ji.

Post-Surgery Confusion: Understanding Neurological Impacts and Recovery

Hello Doctor, my father was hospitalized due to septic shock. After being intubated by the physician, he woke up quite alert (able to write and communicate). Later, he underwent abdominal surgery where the doctor found only distension of the colon and drained approximately 2000cc...

Dr. Ye Boshou reply Neurology
Hello: 1. Medications can affect consciousness. 2. Brain hypoxia can occur in cases of hypotension, hypoglycemia, or lack of oxygen; all three conditions can lead to neuronal damage. 3. Tremors may be a sequela of brain hypoxia.

Understanding Risks of Hydrocephalus Surgery: A Guide for Families

Hello, doctor! Recently, I have read many articles that only describe symptoms, sequelae, and surgical methods. I am inquiring about the risks during the surgical process. The patient has experienced elevated intracranial pressure and has undergone one surgery to remove part of t...

Dr. Hong Weibin reply Neurology
1. General anesthesia typically involves the use of intravenous and inhalational anesthetics to block pain. In a normal human body, the brainstem's respiratory center sends signals to the respiratory muscles to facilitate breathing. However, during the administration of anes...