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Brandon Peters, M.D.

More Extensive Sleep Apnea Surgery Revealed in Girl with Brain Death

By December 21, 2013

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In a court hearing Friday, further details were revealed in the case of 13-year-old Jahi McMath, the teenager who suffered complications leading to brain death after surgery to treat sleep apnea.

While awaiting the opinion of an independent neurologist as ordered by the court, additional information about the procedures preceding the tragic turn of events has been disclosed. She did not have a routine tonsillectomy. Rather, she had three procedures to treat her condition: adenotonsillectomy, uvulopalatopharyngoplasty (UPPP), and turbinate reduction.

Tonsillectomy with or without removal of the adenoids is commonly performed as a treatment of snoring and sleep apnea in children. Turbinate reduction, in which tissues of the nose are removed with a scalpel or shrunken with radiofrequency ablation, may treat polyp-like masses that are often swollen with allergies. UPPP, involving the surgical removal of the uvula and tissues of the soft palate, is not typically performed in children. It is unusual for all three procedures to be performed simultaneously in children to treat sleep apnea.

Bleeding is a known risk for each of these procedures. She was monitored in the intensive care unit (ICU) post-operatively when she began to experience bleeding and subsequently went into cardiac arrest. Further details regarding this event have not been disclosed, but it can be presumed that a lack of blood flow or oxygenation as part of the arrest contribute to brain death.

She was officially declared brain dead on Dec. 12 and subsequent tests, including two EEGs, have not revealed signs that would contradict this declaration. In California, once brain death is declared by a physician, the hospital can legally withdraw support including discontinuation of the ventilator. Once removed, the remaining bodily functions are likely to cease shortly thereafter. Her family has been granted a temporary restraining order that prevents the removal of life-sustaining treatment while further evaluation is arranged.

It is likely that after the independent neurologist verifies brain death that the court will allow Oakland Children's Hospital to turn off the life support. This is undoubtedly an unimaginably painful scenario for her family, but it is clear she will not recover from her current state.

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