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6 day old baby didn't react well to general anaesthesia(81 Posts)
Hi - sorry in advance this is going to be a long one! I suffer from extreme anxiety. My eldest son was born and at the 6 week check they found that one of his testicles had twisted when I had been pregnant with him. Since then I have been very anxious about his remaining ball. I had my third son in September and my anxiety went into overkill. On day 6 (notoriously a bad day apparently!!) I thought one of his balls was a bit larger than the other so decided to check it out in A&E - more for reassurance than anything else. When we arrived it looked completely normal so I thought it must have just been a combination of anxiety and it being positioned funny momentarily. We thought we would just get reassurance from the consultant and been on our way. Anyhow, the consultant decided it wasn't normal and that he should do a scrotal exploration under general anaesthetic. My eldest son had had one at 3 months of age to secure the remaining ball and it had been fine so we were more panicked about the consultant thinking there was something wrong than with the anaesthetic. We were given 5 minutes to decide and felt we had no choice but to go ahead even though his balls looked totally fine to us. A really stupid move. It was meant to be a 20-30 minute operation but two hours later we were told he was out of theatre - no explanation of the delay. And his ball had not twisted and had been absolutely fine - so an operation and general for absolutely no reason. I went down to recovery an hour later and my poor baby wasn't moving, was on oxygen and his stomach was distended so much I could see all his veins. Again, no explanation. He had to stay in hospital for two days during which he was on wafting oxygen and hardly woke, he vomited bright yellow material and his stomach remained distended. We were so relieved when he started to recover and we took him home two days later. His stomach remained distended for a couple of weeks but he started to be more alert each day that went by. He is now nearly 4 months and looks perfectly healthy, gorgeous and meeting milestones. We were so upset that no-one had offered any explanation and requested the operation and anaesthetic records. We aren't medical but it looked like his oxygen levels dropped to 78% for a couple of mminutes and were mainly in the low 90's, that the anaesthetist had given him a large dose of fentanyl (opioid) at the end of the operation and that shortly after his respiratory rate dropped to almost zero. His blood pressure was low and had to be corrected and he had to stay in theatre for an hour after the surgery ended - presumably to stabilise him. The anaesthetist had to stay in recovery with him for 40 minutes as he wasn't breathing appropriately - sleep apnoea. The anaesthetist record also said he had sevoflurane (anaesthetic) in his end tidal breaths for a long time. To learn all this has really bowled me over. For one thing, I have horrendous anxiety and OCD to start with and now my days are spent torturing myself about why was I stupid enough to take him to A&E in the first place, of images of his distended tummy and his ill sleepy face and I have convinced myself that he will get cancer or organ failure because of this. Are there any nurses or anaesthetist out there who can help me understand how bad this is please? We don't really know how common a reaction like this is in a newborn baby. We have complained about the anaesthetist - mainly because we had agreed with the trainee (who was sent to speak to us beforehand) that they would do a caudal with no opioid (which was then disregarded) - but also because of the lack of empathy and communication. Has anyone had their very new baby operated on and have a similar reaction and they've been fine? I just feel sick. My partner won't talk about it - other than hinting that it was me who started the chain of causation - and I can't get on with life or enjoy my baby. Any help/advice gratefully received. x
It might be a good idea to contact PALS and arrange for a debrief so that you can fully understand what happened and why.
I have contacted PALS and the lead anaesthetist apparently ""investigated" the case. However, the report that came back had all the wrong times (different from those on the anaesthetic record) so wasn't accurate. The trainee and anaesthetist had lied about what happened and the report ignored the fact that he had stopped breathing in theatre and also didn't explain why he had been in theatre an extra 90 minutes to that expected.
Basically I don't care who did what and why. I just want to know if there is anyone who can help explain how this could affect my baby long term. As I said, he seems perfectly normal but how bad is low(ish) sats for a short period, why would he get a distended tummy and sick up yellow gunk, what does it mean that there was sevoflurane in his end tidal gases for a long time and is this a normal reaction for a newborn? Has anyone's baby been through something similar? Are there any anaesthetists or child nurses who can offer some light on this? I just can't move forward with this hanging over me. x
I'm a pads nurse but I specialised in A&E so can't answer your questions about the anaesthetic.
However, you mentioned that your DS wasn't breathing properly. Do you know if they used a bag and mask to help him breathe?
If so this usually causes a distended abdomen due to air being pushed into the stomach at the same time as the lungs. Best practice is to pass a nasogastric tube to allow the air to escape.
I'm sorry you've had such a bad time. Organ failure that would occur after surgery as a result of a 'bad' anaesthetic would usually be seen in the hours and days after anaesthesia, so I think you can be reassured by the fact that your baby is developing normally. I don't think there is any link between anaesthetics and cancer, either.
Apnoea and hypotension (low blood pressure) are common side effects of opioid drugs (in sufficient dose) and many anaesthetics will cause a degree of hypotension also.
It would be good if you could meet with the anaesthetist who handled your baby's case, so they can talk you through what happened.
Thanks for your replies. I really appreciate a third party view! Especially a reassuring one!!
He was definitely intubated and on oxygen but not sure what method they use to ventilate a baby during an operation. Wouldn't the tube ensure that gas only was delivered to the lungs? If not, then it does makes sense that that was the reason his stomach was so distended. What about the yellow stuff? I think they said it was gastric acid but not sure why that would be coming up after an operation that was nowhere near his stomach?
Reassuring that low blood pressure and apnoea are common - I had read that apnoea was very rare and an emergency so panicked. She gave a very large dose of opioid right before the operation ended and it was after that he pretty much stopped breathing so it was definitely down to that. But if you stop breathing presumably they breath for you? There was still oxygen going to him from the operation charts. And does anyone know about oxygen saturations? His were generally around the low 90's although for a couple of minutes they dropped to just below 80%. I am worried about brain injury.
He was so sleepy for 48 hours - hardly moving or opening his eyes and I just have that image in my mind all the time. How can a small newborn baby go through all that and be pumped so full of drugs and for it not to have a lasting impact on his health? And what makes me all the more sick is that it was all for nothing - nothing was wrong with his ball and it was a case of the surgeon covering his back at my baby's expense.
But if there had been something wrong, he'd have been the surgeon who was willing to risk operating on a 6 day old baby to save his testicle. He could only make a judgement on his presentation and go from there.
I am sorry you had such a terrible time.
How can a small newborn baby go through all that and be pumped so full of drugs and for it not to have a lasting impact on his health?
Its not surprising you are so anxious following such an traumatic incident. You may be experiencing a PTSD type disorder. Its very common in parents of children who have been dangerously ill.
I am not dismissing your concerns but do you think you would benefit from talking to a specialist in trauma?
Yes I am pretty traumatised!! The guilt I feel is immense. There was no swelling or discolouration which is why I am angry the surgeon decided to operate - it was just the positioning at the time I saw it leaning to one side. I would expect a surgeon to be able to differentiate between a real issue and a mum's anxiety. Also, he made a mess of it and now my son has a cyst on his testicle which may need to be removed under a general anaesthetic and may impact on his fertility. It is just one big mess and I can't stop crying. But you can live happily and healthily with one testicle (my eldest son is living proof) but the problems he had after the anesthetic are a different story. Bizarrely they didn't even put him into intensive care - they just sent him back to the ward with oxygen once he had started breathing again. I want to get an idea of how serious this is. Has anyone else had a newborn operated on and for them to hardly wake for two days? And a distended tummy and yellow crap?? And can anyone offer me an insight into how brain injury would present at 4 months of age? I am just so scared. Also I have read that supplementary oxygen is associated with childhood cancer and he had nearly 100% during the op and for an hour after and then wafting 3L for the next couple of days. And to have so many drugs that it stops you breathing, lowers your blood pressure to a deadly rate and knocks you out for 48 hours must be a cancer risk??
I have worked with young, brain injured children for a long time.
You are asking a very difficult question to answer.
At your son's age I would be expecting to see a delay in meeting milestones.
They may be muscle weakness or stiffness. Abnormal movements like jerking or floppiness.
Signs of visual impairment e.g. not fixing on or following objects or faces.
Lack of interest in their surroundings.
Atypical reactions to stimuli e.g. noise - troubled by ordinary levels of noise/light/movement or not reacting to something that would ordinarily disturb a baby.
Sleepiness or hardly sleeping at all.
Crying all the time or not vocalising all e.g. not when hungry or tired or uncomfortable.
That is not an exhaustive list and not all children have all of those issues.
They are off the top of my head.
You baby is very young. Even if your DS had not gone through anything of the things in your OP, it would be hard to find anyone to tell you 100% he was going to develop normally.
I have had a quick look at the oxygen/cancer thing. I can't claim to any proper understanding of that sort of research. It doesn't seem to have triggered any changes in protocols and the study indicates that further research is need. It also seems to suggest the increases are limited to cancers dx under the age of 1?
Maybe someone with more scientific expertise can help you with that.
I have a feeling, from your posts, that you are not going to be reassured by anything at the moment. That is not meant to be a dig or a criticism.
Perhaps some counselling along with the facts will be beneficial? I mean that working with someone about your trauma may make it possible for you to take on board the other stuff?
My DD didn't have any oxygen at birth. She didn't have any procedures or drugs or any significant illness. She got cancer. Not one medic asked me any questions relevant to yours. She was part of a number of studies and the history taking didn't ask about oxygen or drugs either.
You have previously said that your baby is well and meeting milestones (I think?)
Thank you for posting. It must be hard to hear me bang on about fears for the future when my fears are a reality for you. It is more the guilt I feel for being probably the only m,other who has had her newborn operated when there was absolutely nothing wrong. And then for the medics I put my faith in to let me and him down. My OCD and anxiety are off the wall in any case and no amount of CBT has worked on my minor worries in the past - and now I really do have something to worry about so I can't see counselling helping. I honestly can't see anything working other than drugs and I'm breastfeeding so that's no go. I felt such guilt that my eldest lost a testicle when I was pregnant with him and this just seems very personal to be in a position where my newest baby could also lose one purely because of my anxiety.
As for his development, I think it is ok. No seizures, very alert and interested in his surroundings and grasping objects. But everything 'unusual' scares me when it otherwise wouldnt - excessive drooling, tongue out a lot, not rolling over etc. When i was pregnant I went to extremes to avoid chemicals (didnt wash my face, wear make-up or perfume etc!!), steam cleaned only, ran away from car fumes etc cos I wanted to enjoy this newborn period and I guess I am also very angry at myself for having ruined it all for a moment's madness. Truly gutting.
I have suffered from anxiety for a long time. Its much more under control now thanks to EMDR but it still flares up.
Your posts (please dont be offended) really scream 'anxiety' to me.
That isn't to say that your concerns are totally unfounded. Anxiety is a bastard for taking the tiniest grain of reality and making it into a bloody great pile of terror.
I don't suggest counselling in a glib way. I have been through loads and you are right that certain types of therapy are not that great for anxiety. But some really are. They won't take away your fears but they can help you manage them.
The trouble is that when you are in the midst of an almighty flare up it seems as if nothing will help. I have been there.
I thought 'well therapy won't bring DD back so what is the point? All I want is to have her back'.
Maybe it feels as if therapy won't change what has happened to your son so there is little point in trying?
Your 'normal' state of anxiety has been ramped up to unbearable heights by this horrible incident. That is an awful lot to cope with on your own.
All that guilt and fear is exhausting. I really feel for you
I can't answer all your questions, but for a few bits I can:
About whether it was right to go in for exploratory surgery - it probably was. Once a concern has been raised about a testicle, the clock is really ticking. Waiting to see if things settle or recur/trying for scans...well, if you're lucky everything is fine, but if you're unlucky then that testicle will be dead by the time it's obvious. So the training is generally "if in doubt, check it out".
With regards to the low oxygen levels - please try to relax. From the numbers you described, I would be absolutely gobsmacked if that would have caused any harm. When a baby is so young, they still have haemoglobin (the bit in your blood that carries oxygen) designed for before they are born, so designed to cope with the much lower levels of oxygen they can get second hand via the placenta. We very regularly see babies with cardiac problems who go for days, and weeks, with much lower levels of oxygen than you describe, and without sustaining brain damage from it. Babies are, thankfully, much tougher than us.
Hope that helps a bit. A passing paediatrician.
PS You can specifically ask PALS to get them to take you through things face to face, if you think that would help. It sounds like it might. And it would give you a chance to ask questions. It might help if you draw up a list of questions in advance - you could even print out your postings on here, and use that.
Thank you. Just your words have made me well up. To be sympathetic to someone's troubles when you have been through so much worse takes strength. When did you lose your daughter if you don't mind me asking? I can't imagine the pain and emotional exhaustion of going through diagnosis then treatment and to lose that person at the end of it. Stupidly, deep down I think that if I worry about something and cause myself so much mental anguish in doing so then I have done my "sentence" and it won't happen. Madness, I know. So to hear what you as a fellow anxiety sufferer has been through makes me even more sick. In my case, my anxiety got so bad that I just went to the hospital "reassurance seeking" and of course they felt they had to cover their backs and operate. So now I am in crisis. My partner refuses to talk, my parents are bored by it (4 months on) and I sit and google all the drugs he had and whether they are carcinogenic etc. I'm a right laugh!! I looked up EMDR as I didn't know what it was. I have never heard of it - all I ever get is "why not try CBT?". How has it worked and where do you go if you don't mind me asking? It is worth a try because inflicting my state of mind on my boys is not fair. x
Thanks Nocoolnamesleft! That does help. I did ask PALS questions and got some inaccurate answers so have gone back with a lot more very precise questions. If I don't get the answers I need then it will be a de-brief.
I can understand exploring just in case with an older child or adult but with a 6 day old baby? I just think they should have been nearing 100% sure to do that and it was clear I was a mad woman.
Do you know anything about too much oxygen? They put him on a high dose for a long time and kept trying to get his sats to 100% but I've read that that causes more problems. And he was on wafting for 2 days. We weren't told how to do it and were left to our own devices so we tried to keep it around 98%
Can you recommend any medico legal anesthetists who might be able to go through our medical records with us? I don't trust the lead anesthetist at the hospital as her report was inaccurate, hardly investigated and of course in favour of the anesthetist we were complaining about.
The distended abdomen - did they pump some air into the abdomen during the surgery? This is sometimes done during laparoscopy procedures
Wouldn't need gas in the abdomen for testicular surgery
Fentanyl is a strong opiate and does stop patients breathing. But that is very common in theatre and we also want some patients not to breath for themselves which is why they are highly monitored at all times
The anaesthetist should have been a consultant as it was such a young child
How can the drs be 100% sure as to whether it was a torsion or not? If it is a torsion the testicle doesn't have long before it's dead.
I have been in theatre for nearly 15yrs and I have only seen 2 true torsions. The rest were other issues - and in some cases nothing was found
7mcg and they weighed him as 3.6kg. Was a tiny cut and she gave it 2 mins before they finished the surgery. He also had jaundice so think he just couldn't deal with all the drugs.
I dont think she was a consultant as she is Dr not Ms. I guess they could say it was an emergency so had to use anyone but we wouldnt have taken that risk. We told the trainee (the only person we saw beforehand) that we wanted a caudal and no opioid and she didnt do the caudal and gave fentanyl.
The notes say he had sleep apneoa. It kicked in about 15 mins after the fentanyl. His resp rate was around 3 rising to 8 and back down. How would they make sure oxygen went to his organs. Also his systolic blood pressure webt down to around 25. Apparently they treated this in theatre but I dont know how
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