This week marked the 173rd anniversary of the first surgical procedure done under anesthesia. That happened back in the Civil War era, on October 16, 1846. It was a coincidence that I spent yesterday and today with an anesthesiology medical expert working on a medical malpractice case.
These days, anesthesia is so common that it’s hard to imagine even getting a tooth filled without it. Yet, any time a patient receives general anesthesia, there are a lot of risks that anesthesiologists, certified registered nurse anesthetists (CRNAs), and patients should consider.
Here are some things that you should know to maker anesthesia safer for you:
• Who’s providing anesthesia care in the operating room?
Anesthesiologists are medical doctors with extensive training on how to handle the cardiac, respiratory, and circulatory risks of anesthesia. Certified registered nurse anesthetists (CRNAs) are nurses with additional training in anesthesia.
Some states, like Texas, allow CRNAs great latitude to perform roles that historically were handled by anesthesiologists. Most hospitals and surgery centers allow CRNAs to provide operating room anesthesia care under a medical supervision model. This means that one anesthesiologist may be supervising five CRNAs in different operating rooms at the same time.
From my experience as a Houston, Texas medical malpractice lawyer, CRNAs are able to provide basic anesthesia care, but many of them panic when something goes wrong. When an anesthesiologist isn’t immediately available because he or she is working in one of the other four operating rooms, that can spell trouble for a patient in respiratory or cardiac distress.
Before agreeing to be pawned off on a CRNA, make sure that you’re comfortable with the anesthesiologist’s accessibility during your surgery and the CRNA’s training and experience. Also ask if the anesthesiologist is board certified.
• Be comprehensive in your medical history.
The standard of care requires the anesthesiologist to evaluate and interview the patient before surgery in what’s called a pre-anesthesia evaluation. The purpose of this encounter is to identify any past or present medical conditions and medications that are relevant to the surgery or anesthesia plan.
As a patient, it’s important for you to be honest and comprehensive in providing information about your health and medication history to your anesthesiologist and CRNA. Some medical conditions, like hypertension, sleep apnea, and respiratory or cardiac issues are important for your anesthesia provider to be aware of because they increase your risk of experiencing complications under general anesthesia. The same is true for medications.
A competent anesthesiologist or CRNA will obtain and use this information to make appropriate preparations to handle potential emergencies. This may involve having extra airway supplies to handle a difficult airway intubation or having the crash cart ready in the operating room.
• Ask about a pre-surgical cardiac workup.
Surgeons and anesthesia providers vary in whether they routinely order a cardiac workup before taking patients to the operating room. Some doctors think it’s unnecessary to do any heart workup at all unless there are clear risk factors.
Even without a clear cardiac or respiratory diagnosis, many medical experts recommend a pre-operative cardiac workup for patients who are overweight or obese, have sleep apnea, or have high blood pressure. At a minimum, this would include a 12-lead EKG.
This quick and inexpensive study can be done by a cardiologist before the day of surgery or by the anesthesia provider in the operating room. A 12-lead EKG identifies serious heart conditions. Some patients headed to surgery have undiscovered heart diseases that make going under general anesthesia a life-threatening risk. In those situations, the standard of care requires canceling surgery until the cardiac issues are addressed.
If you’ve been seriously injured because of poor anesthesia or operating room care, then contact a top-rated experienced Houston, Texas medical malpractice attorney for help in evaluating your potential case.