I'm scheduled to give anesthesia for a PEG. The patient has been having recurrent aspiration. In preop the patient was breathing about 40 times per minute. Room air O2 sat was 89%. "This doesn't look optimal for a MAC anesthesia," I thought. I start looking through her chart.
In the H+P in the very first paragraph the physician had dictated that the patient had a complete esophagectomy last year. Huh? WTF. She's scheduled for a PEG? Her GI doctor walks in. "Are we ready to get the patient into the room?" he inquires. "Uh, Dr. GI, did you know she had a total esophagectomy last year? Does she have a colon interposition or gastric pull up?" I asked. "Really, she had an esophagectomy? I didn't even know that," he replies stunned.
There is no mention of the type of esophagectomy in the H+P so we look at her CT scan. "Esophagectomy with gastric pull up" is what the radiologist dictated. "So Dr. GI, do you plan on putting the PEG through the patient's left ventricle?" Clearly embarrassed Dr. GI replies, "God I feel like such a bonehead. I'm going to schedule her with interventional radiology to get her feeding tube in. Thank you for looking out for my patient."
"Just doing my job Dr. GI." And that's why we need anesthesiologists.