A Dallas anesthesiologist was sentenced Wednesday to 190 years in prison for injecting a nerve-blocking agent and other drugs into bags of intravenous fluid at a surgical center where he worked, leading to the death of a coworker and causing cardiac emergencies for several patients.

The emergencies began two days after Raynaldo Riviera Ortiz Jr. was notified of a disciplinary inquiry into an incident during which he allegedly “deviated from the standard of care” during an anesthesia procedure when a patient experienced a medical emergency.