How could Joan Rivers routine procedure go so wrong?
Comedic legend Joan Rivers passed away last Thursday after complications during a routine throat surgery. Her funeral is scheduled to be held this Sunday at Temple…
Joan Rivers was hospitalized last week after she went into cardiac arrest and respiratory at Yorkville Endoscopy following a minor, elective vocal cord procedure. (Photo by Jeff Schear/Getty Images for Michigan Avenue Magazine)
Comedic legend Joan Rivers passed away last Thursday after complications during a routine throat surgery. Her funeral is scheduled to be held this Sunday at Temple Emmanual-El in Manhattan, where friends and family can come to pay their respects. Though the grieving process is underway for many, some still have questions of how a routine procedure could go awry.
SEE ALSO: Joan Rivers passes away at 81
According to reports, Rivers went into cardiac arrest during a non-surgical procedure at Yorkville Endoscopy in New York City. Not long after the well-known celebrity was rushed from the clinic to a hospital, rumors started to circulate Yorkville Endoscopy had somehow botched the procedure. Investigators have already visited the clinic, and while no wrongdoing is suspected at this time and investigation is still underway.
Why Joan Rivers was having throat endoscopy?
Details on why Joan Rivers was having a medical procedure done are vague, but E! News reports she was visiting the clinic to have her vocal cords examined. Those who are familiar with Rivers know she had a hoarse voice that seemed to worsen as she aged, and monitoring the vocal cords was a reasonable course of action for the 81-year-old.
James P. Thomas, MD, of voicedoctor.net, explains on his website the endoscopic examination of the vocal cords is called a laryngoscopy.
This procedure is commonly done in a hospital or clinic setting as an outpatient procedure. For most individuals, general anesthesia (induced unconsciousness) is not necessary; topical anesthetics usually block enough sensation to prevent gagging and discomfort.
“An endoscope, to view the voice box around the corners of the nose and mouth, and anesthesia, to prevent gagging, sneezing, retching, discomfort and obtain an ultra close view of the vocal folds, are the first two essential components. There are two types of laryngoscopies, rigid and flexible, and accompanying anesthesia,” Thomas indicates. “Topical anesthesia such as lidocaine may be sprayed onto the soft palate, posterior pharynx and base of tongue. I use 4% lidocaine combined with 1 percent Benzylkonium Chloride, 1 percent Phenylephrine, peppermint flavoring, and Stevia sweetener. Some people can be examined without anesthesia, although many cannot. I prefer a longer, more thorough exam, rather than a brief glimpse. Most of the gag seems to come from the back of the tongue. Touching the back wall of the pharynx in most people does not cause a gag.”
So if Joan Rivers was awake, why did she go into cardiac arrest?
Joan Rivers, the raucous, acid-tongued comedian who crashed the male-dominated realm of late-night talk shows and turned Hollywood red carpets into danger zones for badly dressed celebrities, died Thursday, Sept. 4, 2014. She was 81. Rivers was hospitalized Aug. 28, after going into cardiac arrest at a doctor’s office.( Photo by J. Countess/Getty Images)
The answer may be that she wasn’t under topical anesthetics, that she may have been under general anesthesia instead. Some clinics–and some patients–opt for general anesthesia because it eliminates the chance the patient will move or be uncomfortable. Some individuals do not respond as positively to topical anesthetics and need a stronger method of sedation.
General anesthesia comes with significantly more risks. The American College of Cardiology (ACC) states general anesthesia suppresses many of the body’s normal functions such as breathing, heartbeat, circulation of the blood (such as blood pressure), movements of the digestive system, and throat reflexes such as swallowing, coughing, or gagging. Because of this, anesthesia must be monitored closely to ensure vital functions do not cease completely.
“Serious side effects of general anesthesia are uncommon in people who are otherwise healthy. But because general anesthesia affects the whole body, it is more likely to cause side effects than local or regional anesthesia,” says the ACC. “Fortunately, most side effects of general anesthesia are minor and can be easily managed. Other serious risks of general anesthesia include changes in blood pressure or heart rate or rhythm, heart attack, or stroke. Death or serious illness or injury due solely to anesthesia is rare and is usually also related to complications from the surgery.”
SEE ALSO: Joan Rivers is remembered for pushing comedic boundaries
Due to Joan Rivers’ age, she automatically entered a higher risk category when it came to general anesthesia. It is also possible she had unknown, underlying health conditions that would have made her a poor candidate for full sedation.
At this time, no more details have been made known about the procedure or the anesthetics used. Family and friends must wait for the investigation to finish before they will know if any negligence also came into play. Because anesthetics must be monitored closely, there is always room for human error on the part of the overseeing doctor.
