Monday, October 27, 2014

The Most Important Question To Ask Before Surgery

Today's issue of the Wall Street Journal has a nice little article advising patients how they should discuss their anesthetic care with their anesthesiologist. Since it's in the WSJ, you know every anesthesiologist in the country has already read it this morning. So we're well prepared for the onslaught of questions by the well to do patients and readership of the paper. It goes into the some statistics about the safety of today's anesthesia: 3 deaths per 10,000 procedures and a 4.8% anesthesia complication rate according to one study.Those numbers seem high to me but that's the conclusion they reached.

Naturally they have to bring up the death of Joan Rivers. What they failed to mention, but which I already have, is that no anesthesiologist was involved in her care immediately before she went into respiratory and cardiac arrest. The article's best suggestion may have been this blurb, "Find out who will monitor you during the procedure—the surgeon, a nurse or an anesthesiologist. Only a medical professional specifically trained to administer anesthesia and monitor patients should care for you throughout a procedure." Presumably the surgeon has not been formally trained in administering anesthesia. So unless he is double boarded in surgery and anesthesiology and he tells you he will give instructions to the nurse on what drugs to push for sedation, get ready to run the hell out the door. I wonder how the morbidity and mortality figures from that study would have changed if only anesthesiologist provided care was used to calculate its results?

We anesthesiologists don't presume to understand how other doctors do their jobs. We don't want to know how to perform an endoscopy or a cardiac cath. Yet these non anesthesia trained doctors are so arrogant as to assume they know how to provide dangerous anesthetic drugs while performing their procedures at the same time. So Dr. Murray, Dr. Cohen, and all you other procedurists out there who are putting your patients to sleep out of expeditiousness and greed without any anesthesia training, I hope you start getting a lot of hard questions about why you're not using an anesthesiologist for this most risky portion of a case.

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