699. Liposuction Death - Practice guidelines for safe sedation

Straits Times, oct 20, 2011 Pg A4
Liposuction Death - I did not cause death, says doctor

Patient: Mr Heng went to Reves Clinic in Orchard Rd on Dec 30, 2009 for a liposuction and fat-transfer operation.

Doctor 1: Dr Jim Wong did the surgery. Set up nfusion pump which administers drugs including propofol into the patient.

Doctor 2: Dr Zhu Xiu Chun @ Dr Myint Myint Kyi - monitor the patient's vital signs. Continuous oxygen supply, equipment measuring the vital signs was in place.

Said readings were within an acceptable range, no snoring or other abnormal respiratory movement to sugestg that Mr Heng' airway was disturbed. If the patient did not move much, he was quite sedated and dosage of propofol would be adjusted lower. If he moved or made sounds, after making sure that vital signs were staable, the dosage would be increased. Moderate sedation - responsive to tactile sensation.

Procedure: 12.30 pm to 3.50 pm
25 minutes after end of procedue, Dr Zhu was told there was an emergency. Mr Heng was pale and unresponsive and died.

Autopsy: >10 puncture wounds in intestines, liver

Question: Mr Heng's rep said that Mr Heng did not show any overt signs of pain because he was more than moderately sedated as multiple punctures in his internal organs from liposuction would be very painful.

MINISTRY OF HEALTH GUIDELINES FOR SAFE SEDATION

1. The changes in dosage of propofol had NOT been recorded. This was unsatisfactory.
2. The patient's vital signs were recorded every 15 minutes. Every 5 minutes would be better. Vital signs include pulse rate, blood pressure, oxygen saturation

In an earlier inquest - fact finding rather than determination of who was to blame for Mr Heng's death, two experts mentioned that the patient was over-sedated.