Cancel a PHACO?

[Laurel123]

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This subject came up at our last meeting...

When do you cancel a Phaco done under a little versed/fentanyl and topical anesthesia?

I have definitely done some ASA 4 patients in the outpatient center. I pretty much will go ahead as long as they aren't having unstable angina, an MI, ventricular tachycardia or fulminant pulmonary edema or something.

But recently a lady was cancelled for having some high sugars. (about 315) But she wasn't taking any diabetic medications and hasn't for a long time. To me, the high sugar is her baseline. Of course, she should go get it checked out ASAP by primary care, but obviously she had been functioning day everyday on a relatively active level and I would have gone ahead?

Agree

 

[The_Sensei]

This subject came up at our last meeting...

When do you cancel a Phaco done under a little versed/fentanyl and topical anesthesia?

When the patient is dead.

 

[militarymd]

Hyperglycemia can cause osmotic changes in the lens of the eye...causing distortion........

I suppose if this ocular distortion "May be" a reason for the Surgeon to not do the case....

but otherwise....if they can walk into the OR, they should be able to have a phaco.

 

[Laurel123]

When the patient is dead.

ha! Though some of those squirrelly PHACO patients can drive us nuts.

 

[Planktonmd]

So lets say you do the SX, and you let the patient leave with 315 of blood sugar advising her to see her primary "ASAP".
2 days later you hear that she developped DKA and was admitted to the hospital where they overhydrated her so she went into CHF / pulm. edema and as a result suffered severe hypoxic brain injury and is now a vegetable!
Although you know that your anesthetic had nothing to do with her bad luck, You worry a little but few months pass and you almost forget about her.
one day you get a letter of intent from Mr. sleeze bag Jd. her lawyer accusing you among other things of "gross negligence".
You worry more, and you get ready for a long lasting agony.
Do you think this story is too far from reality?

 

[The_Sensei]

So lets say you do the SX, and you let the patient leave with 315 of blood sugar advising her to see her primary "ASAP".
2 days later you hear that she developped DKA and was admitted to the hospital where they overhydrated her so she went into CHF / pulm. edema and as a result suffered severe hypoxic brain injury and is now a vegetable!
Although you know that your anesthetic had nothing to do with her bad luck, You worry a little but few months pass and you almost forget about her.
one day you get a letter of intent from Mr. sleeze bag Jd. her lawyer accusing you among other things of "gross negligence".
You worry more, and you get ready for a long lasting agony.
Do you think this story is too far from reality?

If you have advised AND DOCUMENTED that the patient is to see their PCP, then you have done your part. What are you going to do, drag them to their family practitioner by the hair?

 

[Planktonmd]

There will be 10 professors of Anesthesiology who will gladly testify that what you did was negligent and not the standard of care.
They will most likely say that the diabetes should have been addressed before proceeding with elective surgery, especially that the patient was obviously either untreated or uncompliant.
Some of these professors will be people who taught you anesthesia.
But don't worry your lawyer will find 10 other Professors who will say that what you did was the wisest thing ever and that they would let you treat their mothers any day!
A couple of years later your insurance company will settle out of court.

 

[Laurel123]

There will be 10 professors of Anesthesiology who will gladly testify that what you did was negligent and not the standard of care.
They will most likely say that the diabetes should have been addressed before proceeding with elective surgery, especially that the patient was obviously either untreated or uncompliant.
Some of these professors will be people who taught you anesthesia.
But don't worry your lawyer will find 10 other Professors who will say that what you did was the wisest thing ever and that they would let you treat their mothers any day!
A couple of years later your insurance company will settle out of court.

I see your point. And this is a litiginous society we live in, so I do agree that it is something that we have to consider. But outside of lawsuits, I still believe that I would proceed with surgery. I believe that it is safe for her to proceed with surgery and that after a brief stint in the PACU, she will be completely back to baseline. My responsibility would be a tell her that she has disease and needs follow-up. However, unless I believe she needs to be admitted to the hospital, I think she is fine to go along with her life. Honestly, I never check a post-op sugar after PHACO's in type 2 diabetics.

 

[The_Sensei]

There will be 10 professors of Anesthesiology who will gladly testify that what you did was negligent and not the standard of care.
They will most likely say that the diabetes should have been addressed before proceeding with elective surgery, especially that the patient was obviously either untreated or uncompliant.
Some of these professors will be people who taught you anesthesia.
But don't worry your lawyer will find 10 other Professors who will say that what you did was the wisest thing ever and that they would let you treat their mothers any day!
A couple of years later your insurance company will settle out of court.

How true, and yet......how sad.

 

[militarymd]

So.......we're back to doing what the J.D.'s tell us to do??????

 

[foxtrot]

Hyperglycemia can cause osmotic changes in the lens of the eye...causing distortion........

I suppose if this ocular distortion "May be" a reason for the Surgeon to not do the case....

but otherwise....if they can walk into the OR, they should be able to have a phaco.

Brilliant, just Brilliant!!!

 

[foxtrot]

Hyperglycemia can cause osmotic changes in the lens of the eye...causing distortion........

I suppose if this ocular distortion "May be" a reason for the Surgeon to not do the case....

but otherwise....if they can walk into the OR, they should be able to have a phaco.

Brilliant, just Brilliant!!! 😀