What is respiratory acidosis and how can it kill a patient after surgery?

A man or woman is scheduled for a routine elective surgery. They walk into a hospital or surgery center, but the day tragically ends with the person’s death. Because it was so sudden and unexpected, an autopsy is ordered. The family is anxious to see the autopsy report, but when it finally comes in they’re surprised to read that the cause of death was cardiac arrest, congestive heart failure, or something else related to the heart.

I bet someone calls Painter Law Firm every week with a story like this. Sometimes these grieving people feel a bit guilty because well-meaning family members and friends urge them to move on. After all, the autopsy blames the death on heart disease, which means nothing could have been done to save the loved one. Are they right? Not so fast.

The truth is that there’s often more to autopsy reports than meets the eye. It’s important to keep in mind that everyone—yes, everyone—ultimately dies of heart failure. The question that often merits a thorough medical negligence investigation is what caused the person’s heart to fail in the first place.

In my experience as a Houston, Texas medical malpractice attorney, a lot of these cases involve botched anesthesia and nursing care during and following surgery.

It’s common for hospitals and ambulatory surgery centers to have anesthesia providers taking care of several patients at once. In other situations, operating rooms are so heavily scheduled back to back that nursing staff is pressured to get patients moved out of operating rooms as quickly as possible, so they can be set up for new patients.

Both of these factors sometimes come to play when patients that are coming out of anesthesia (emergence) and having the breathing tube removed (extubated) struggle to breathe on their own. When the patient is combative, or flailing around, at this stage, it’s an emergency situation called impending respiratory arrest.

Fortunately, the solution is pretty simple. Within four minutes of a nurse or other provider observing combative behavior upon emergence and extubation, the standard of care requires securing the patient’s airway through re-intubation (inserting a new breathing tube) and providing ventilatory support.

Because time is of the essence, it makes no sense that the nursing staff and anesthesia providers would proceed to transfer a combative patient emerging from anesthesia from the operating room to the recovery area. Believe it or not, that’s exactly what happened in a case I’m currently handling against a Houston ambulatory surgery center and other providers.

If impending respiratory arrest is not immediately treated by securing the patient’s airway and providing ventilation support, it’ll progress into full-blown respiratory arrest. That triggers a cascade of problems that can kill a patient. Quite often the cause of death on an autopsy and death certificate will say that the patient died from a heart problem. Let me explain why.

The deadly role of respiratory acidosis

When patients go into respiratory arrest, they aren’t breathing. That triggers hypoxia (insufficient oxygen supply) and hypercarbia (high carbon dioxide in the bloodstream) and respiratory acidosis.


Respiratory acidosis is the condition where a person’s lungs can’t remove enough of the carbon dioxide produced by the body, which leads to an excess buildup of carbonic acid. Respiratory acidosis cripples the cardiac/circulatory system by causing a long list of problems, including:

• Weak contractions of the heart muscle (negative inotropy)

• Peripheral vasodilatation, the expansion of distal blood vessels, which routes blood away from vital organs

• Heart arrhythmia

• Problems with oxygen uptake in the lungs

In my view, anesthesia providers, including anesthesiologist physicians and certified registered nurse anesthetist (CRNAs) are the best-trained individuals for restoring a patient’s airway in an emergency situation. Under the standard of care, they should be nearby and immediately available to act.

If the nurses dawdle around and don’t call a code or get immediate medical attention, precious minutes are wasted, making it harder to resuscitate the patient. It doesn’t take long until this vicious cycle of respiratory acidosis causes a heart attack and failure.

Why experience matters

This is an example of why it’s important for patients and family members with potential medical malpractice and wrongful death cases to hire an attorney with ample experience in Texas medical malpractice cases. Experienced attorneys aren’t distracted by a conclusory cause of death on the death certificate or autopsy, but have the tools to do a thorough investigation to uncover what really happened.

We are here to help

If you or a loved one has been seriously injured because of poor medical or hospital care, click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.

All consultations are free, and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Beaumont, and Waco.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.