Unusual anaesthesia/cosmetic surgery risk

[Guest guest]

updated 10:19 a.m. ET March 26, 2008

People

 

Cheerleader's death highlights rare risk

 

High school senior dies after undergoing cosmetic breast surgery

 

By Mike Celizic

TODAYShow.com contributor

Stephanie Kuleba’s friends called her “Sunshineâ€

because that was the perfect nickname for the outgoing and bubbly girl

who was everybody’s friend, the cheerleader with the

near-perfect grade-point average who was too nice and too perfect for

anybody to resent.

 

“She was just the kind of girl that everyone loved,†a

friend, Dayna Mercer, told NBC News. “There was nothing bad

about her.â€

 

But the 18-year-old high school senior, who was headed to college and

then medical school, felt she needed to be even more perfect. Her

breasts were asymmetrical and she had an inverted areola, so she went to

an outpatient cosmetic surgery clinic in Boca Raton, Fla., to have what

she saw as a problem attended to by doctors.

 

And now she’s dead.

 

She died Sunday, 24 hours after undergoing surgery, the victim of an

extremely rare reaction to anesthesia called malignant hyperthermia.

 

Usually genetic and very difficult to detect, the condition causes the

body temperature to spike as high as 112 degrees and salts to

precipitate out of the blood. If the reaction is not recognized almost

immediately and an antidote given, it is fatal.

 

The death has focused attention on elective breast augmentation surgery,

a procedure that 347,500 women of all ages chose to have in 2007 alone.

That number is 6 percent higher than in 2006 and 64 percent higher than

in 2000.

 

Although the FDA recommends that only women 18 or older get breast

implants, the number of girls under that age submitting themselves to

the surgery continues to grow. In 2005, the last year for which full

statistics are available, more than 3,500 girls had breast implants.

 

But Dr. Richard D’Amico, the president of the American Society

of Plastic Surgeons, told TODAY’s Matt Lauer on Wednesday that

what happened to Kuleba could happen to anyone.

 

“This young lady’s death is a tragedy. Our hearts go out

to her family. It’s a devastating event,†he said. But,

he added, “this is something that can happen in any surgery, on

any part of the body, in any setting.â€

 

D’Amico encountered it once during what should have been routine

nasal surgery on a male patient. He said he was lucky; his

anesthesiologist immediately recognized the signs of malignant

hyperthermia and took remedial action quickly enough to save the

man’s life.

“There’s a medication for this that needs to be given

very quickly, which was done,†D’Amico said.

 

The problem is that there’s no easy way to identify people who

are at risk of the syndrome.

 

“Most often, there isn’t a clue,†he said.

“The only test to predict it, you’d have to cut out some

muscles from a leg and there’s only five places in the country

that can do this.â€

Kuleba’s family, who did not wish to be interviewed, has hired

an attorney to investigate the death. The doctor who performed the

surgery, Dr. Steven Schuster, also declined to comment.

 

D’Amico repeated the FDA recommendation that no one under 18

undergo breast augmentation surgery. Despite its popularity, the

procedure does have a high rate of complications and often requires

additional surgery within five to 10 years of the original surgery.

“The development of the breast is a very sensitive issue with

young women and very important to them,†D’Amico said.

 

He recommended that anyone contemplating any cosmetic procedure seek out

a board-certified plastic surgeon in a big clinic with a good

reputation. But, he warned, as Kuleba’s case so sadly

emphasizes, no surgery is completely safe.

 

" There's never no risk, " he said. " Our job is to minimize that risk, and

we stay up very late to do that. "

© 2007 MSNBC