WPW and outpatient surgery

[leaverus]

Doesn't seem to be a whole lot of data out there about this patient population and outpatient procedures so I just wanted to take an informal poll:

pt with known wpw (optimized on antiarrhythmics) ok for freestanding surgery center?
absolutely not?
depends on procedure?
matters whether it's an adult or kid?

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[Laryngophed]

I think my oral board answer would be for them to be done at the associated hospital with available critical care and cardiology services should they be needed. The likelihood that they'd be needed? Not sure. The likelihood that those services would be able to make real, life changing interventions should they have an episode of said tachyarrythmia? Dunno, not great. But you'd have a pharmacy stocked full of antiarrythmics, hopefully lots of extra hands, and those services. And that'll be my story when asked in a few years in a hotel room full of awkward silences and stares.

 

[fakin' the funk]

Doesn't seem to be a whole lot of data out there about this patient population and outpatient procedures so I just wanted to take an informal poll:

pt with known wpw (optimized on antiarrhythmics) ok for freestanding surgery center?
absolutely not?
depends on procedure?
matters whether it's an adult or kid?

Do you do adults with paroxysmal Afib at the surgicenter?

 

[caligas]

Doesn't seem to be a whole lot of data out there about this patient population and outpatient procedures so I just wanted to take an informal poll:

pt with known wpw (optimized on antiarrhythmics) ok for freestanding surgery center?
absolutely not?
depends on procedure?
matters whether it's an adult or kid?

Proceed at surgery center. Might end up being the healthiest patient you do that day.

 

[GravelRider]

Take a history of the patient... (gasp!)

If there has been no history suggestive of a tachyarrhythmia (syncope, palpitations, dizziness) then I would say it is safe to proceed at the surgery center. Sudden cardiac death is still rare even in patients with pre-excitation on EKG. If the patient does develop atrial fibrillation, you often have to proceed straight to cardioversion and avoid AV nodal blocking drugs (adenosine, CCBs, beta blockers).

 

[Phyzicz]

Do it anywhere but have pads on the patient and have procainamide and know how to give it. If unsure of anything give amio.

I like the history part. Excellent. But also remember there may be no symptoms and no pre-excitation. You only see W/NCT sometimes intra-op then it's off to the races.

 

[Doctor4Life1769]

Stress testing can give some answers but I agree otherwise with the above.

 

[OB1🤙]

I took care of a guy for total hip last week who had hx of WPW, currently active and asymptomatic.

As it turned out, the wpw wasn't an issue. Malignant hyperthermia, however, was a very very big issue!

 

[Planktonmd]

I took care of a guy for total hip last week who had hx of WPW, currently active and asymptomatic.

As it turned out, the wpw wasn't an issue. Malignant hyperthermia, however, was a very very big issue!

That's just great!!!

 

[Planktonmd]

I am sure you have a defibrillator at the ASC... So, what else do you need?

 

[Chloroform4Life]

Prop sux tube

 

[deleted162650]

I took care of a guy for total hip last week who had hx of WPW, currently active and asymptomatic.

As it turned out, the wpw wasn't an issue. Malignant hyperthermia, however, was a very very big issue!

Why were you doing a hip under GA?

 

[leaverus]

yes we definitely do pts with parox afib at the ASC but we don't routinely place cardioversion pads on those pts. if you're worried enough about risk of arrhythmia to place pads on the pt and have an antiarrhythmic readily available, why do it at the ASC then with fewer resources available than the hospital? and if you guys' group(s) anything like mine there is a spectrum of MDs with varying degrees of risk tolerance; would you greenlight the case for an ASC not knowing who'd actually be assigned to the case the day of surgery?

 

[caligas]

Why were you doing a hip under GA?

Hospital was out of exparel.

 

[Planktonmd]

Hospital was out of exparel.

 

[Chloroform4Life]

I don't get the joke... if it is a joke....

What does exparel have to do with spinal vs general? I do spinal for all my hips and we don't have exparel.

 

[Planktonmd]

I don't get the joke... if it is a joke....

What does exparel have to do with spinal vs general? I do spinal for all my hips and we don't have exparel.

You actually do regional anesthesia WITHOUT Exparel???

 

[OB1🤙]

Ha! I usually do hips under regional but for a number of reasons general was more appropriate in this patient.

 

[deleted162650]

Ha! I usually do hips under regional but for a number of reasons general was more appropriate in this patient.

Apparently Not!

 

[Phyzicz]

What other resources do you need besides defibrillator and anti-arrhythmics that you are afraid of office or ASC? Are you going to crack the chest ???