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Joan Rivers: Sedation Gone Wrong?

By Charlotte Libov   |   Friday, 29 Aug 2014 11:38 AM

Sedation always holds risks, and Joan Rivers’ medical crisis highlights the fact that the dangers are greater for older patients, say experts.

The 81-year-old comedienne is in serious condition in a New York hospital after suffering cardiac arrest during an endoscopic procedure to treat her vocal cords, according to reports.

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Although it is not known if sedation caused Rivers’ heart to stop, patients typically would be put under during such a procedure. For someone of Rivers’ age, the risks are higher than for younger patients, according to a top internist.  

 “Realistically, you might expect that a person of 81 is more fragile than someone who is 61, so you have to be very careful,” Marc Leavey, M.D., a board-certified internist at Mercy Medical Center in Baltimore told Newsmax Health.

After suffering cardiac arrest, Rivers was rushed from the outpatient endoscopic clinic to Mount Sinai Hospital, where she was reportedly placed in a medically induced coma and is on life support.

On Sunday, Rivers' daughter Melissa said family members are "keeping our fingers crossed," according to a hospital statement.

 Rivers had appeared to be in good health and energetic during a public appearance the day before her crisis.  

 During endoscopic throat procedures, a tube with instruments and a camera is typically inserted down the throat. Usually some type of sedation is used for the patient’s comfort, either “moderate” sedation in which the patient is awake but relaxed, or “deep” sedation, using a drug such as propofol.

 In either case, the medication is delivered intravenously, according to the American College of Gastroenterology. 

 It is not clear whether sedation is to blame for Rivers cardiac arrest, but the dangers of anesthesia should always be carefully assessed when an elderly person undergoes a medical procedure – even when it is considered minor, said Dr. Leavey.

 “Outpatient clinics must be selected very carefully because there is always the concern in procedures where sedation is used that something can go wrong very quickly,” he said. “You have to act in minutes. You don’t have the luxury of wondering what do when something goes wrong.”

 Dr. Leavey says it’s important to ask these questions before undergoing an outpatient procedure that requires sedation:  

  • Will a certified, registered anesthesiologist or nurse anesthetist administer the sedation?
  • Is the clinic is equipped with emergency devices including a crash cart, EKG machine, and cardiac defibrillator?
  • Does the clinic have an agreement with a nearby hospital for fast transfer should complications occur?
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“In addition, you should always feel free to question your doctor about your options as to where the procedure is to be performed,” said Dr. Leavey.

 “Ask your doctor about the track record of the clinic. Ask what they will do if something goes wrong. There’s nothing wrong with asking questions like this.”

Rivers is considered a pioneer for women in stand-up comedy. The Brooklyn native, who graduated Phi Beta Kappa from Barnard College, played the comedy club scene in New York in the 1960s. She is also known for her penchant for plastic surgery and for being a tireless worker.

Joan starred alongside her daughter in the WE TV reality show "Joan & Melissa: Joan Knows Best?"

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