You are not an anesthesiologist, or are you?
So how can YOU discuss the anesthesia choice with a patient if it is not even your area of expertise? Pt's wishes are important but both the pt and you have to realize that there are numerous situations when MAC is not indicated/unsafe ...as is toradol for your pts 😉
Nope, not an anesthesiologist and it would be the height of arrogance for me to assume I know best about anesthesia and airway management. I'm sorry if I gave that impression but...
I actually do find it helpful sometimes when the surgeon has discussed anesthesia with the patient. Not when the patient is promised something the anesthesiologist cannot deliver, but when they tell the patient something vague like "usually I use a lot of local and we do it awake" or "you have to be asleep for this."
This gives me some expectations to work with, an idea of how complex the surgical procedure will be if I haven't had the chance to speak with the surgeon ahead of time, and still allows room to correct any misconceptions.
I agree that it is really helpful if the surgeon explains the anesthetic options to the patient, especially in private practice where we usually don't see the patient until the day of surgery, but this also requires good communication between the surgeon and the anesthesia team which is not always the case.
When the surgeon is not certain what the anesthesiologist's plan is going to be, it would be better for everyone if the discussion covers all the possible options without prejudice towards any specific plan.
THIS is what I do in private practice. Patients ASK what the options are when we are discussing surgery. They WANT to know my opinion about what's usually done and it offers me the opportunity to correct some misconceptions about anesthesia. However, I ALWAYS preface it with the statement that the decision is up to the anesthesiologist as to what's safest and the best choice and that I defer to them on that.
In PP, as Plank notes, there is no pre-op clinic where patients are seen and evaluated by anesthesia. They are seen right before the case. I use the same group at every hospital I go to save one, and these guys are friends of mine. We socialize together, talk about cases and I have no problem picking up the cell and calling if I need advice/information, etc. It HAS to be a team approach. I know they like knowing what the patient's preferences are, what kind of case I'm doing, the expected length, blood loss, etc. and they know that I trust them to do what's right and safe for the patient. This is not about me as the surgeon deciding what anesthesia to provide to them.
Surgeons and NSAIDs....sigh (alright, ketorolac dose inhibit platelet function, but we're using parecoxib which doesn't and we still can't get some surgeons to agree to it....some of the sneaky consultants just give it anyway).
Yes, unfortunately there's a lot of voodoo in medicine rather than EBM and surgeons can be resistant to change. However, as you note ketorolac does inhibit PLTs and unfortunately, I've had to take back a couple of patients for bleeding and the only thing different between them and anyone else was the use of Toradol. It may be voodoo/presumption but my cases aren't particularly painful, there's a lot of places little bleeders can hide in the fat and when you can avoid even the small possibility that the Toradol contributes to any post-operative bleeding, why wouldn't you? Its just the right thing to do for the patient to avoid the possibility of coming back to the OR for hematoma evacuation. I can't help but see no difference in post op pain +/- ketorolac frankly.
MAC= Monitored Anesthesia Care
It used to mean minimal sedation and just standing by but now it means any type of anesthetic that does not involve airway instrumentation.
The reason why surgeons like it is because it makes them feel great about their surgical technique and they think that as long as the patient does need a tube then their surgery must be so smooth that it does not cause pain!
Eh...my ego doesn't depend on the type of anesthesia. Patients never complain about post-op pain or what their scar looks like. They complain about stuff that sometimes doesn't even involve me (ie, nurses mean, tape burn from dressing, couldn't find parking at surgery center, sore throat from tube, PONV).
🙄 So to make my life easier, I try to cut down on complaints where
I can.
The reason I like MAC (which yes, any type of anesthetic which does not involve a tube) is not because the patients think they have less pain but because I don't have to hear the afore-mentioned complaints about sore throat and how quickly they got home after surgery!
