Thursday, September 14, 2006

Hard decisions

Over the past few weeks I have been learning about pre-operative assessment with regards to risks specific to surgery and anaesthetics. This has involved identifying key conditions (e.g. severe aortic stenosis) which may impact upon how anaesthesia is performed. I have then been putting this into practice and clerking patients before their surgery, making note of key conditions and considerations and specific assessment for anaesthesia – airway assessment, etc.

Until today this wasn’t too complicated as the most difficult issues I have dealt with were severe arthritis of the neck resulting in an inability to perform a standard intubation and allergies to some of the commonly used agents.

Today was somewhat more challenging however. I attended the preoperative assessment clinic where potentially complicated patients have already been identified through routine nurse-led clerking. One patient was particularly difficult (clinically) and quite upsetting as an observer.

The patient was an elderly woman who was to undergo major abdominal surgery. As well as this she had a significant history of respiratory and cardiac disease with coronary artery bypass surgery and pacing unable to control a longstanding history of unstable angina.

This lady was then told that she had to make a decision as to whether she had the surgery with a significant risk of peri-operative death or did nothing. A tough decision and certainly not one I would lightly make for myself or my patients…

12 Comments:

Blogger Jeff said...

I hope you may consider becoming a noninvasive cardiologists.

If an interventional cardiologist told me I needed a CABG,, I wouldn't be looking for a surgeon, I'd seek out a second opinion from a good noninvasive heart doc.

In April 2004, I was told I was a walking time bomb and needed a quintuple bypass. I sought a second opinion, started on medication and am still ticking. Now was my time bomb a dud, or was the interventional cardiologist one? Check out my blog at http://wordworks2001.blogspot.com

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