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Physician / Resident Forums [ MD / DO ]
Anesthesiology
Positive stress test for non cardiac surgery
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<blockquote data-quote="deleted682700" data-source="post: 22238063"><p>I will tell the surgeon to minimize the intraperitoneal pressure during laparoscopy. Only inflate to pressures that you need to get the surgery done quickly. i will put a TEE probe and ask my cardiac anesthesia colleague to stand by. I have had a 48 yr old patient with Positive family history (brother having had Cabg at 52 yrs old and mother had CABG At 65 yrs old. And a positIve stress test For laparoscopic ventral hernia repair. The cardiologist in upstate New York hospital cleared the patient and it was assigned to me ( Locum )anesthesiologist. </p><p></p><p>I talked to the surgeon about the risk and he was adamant that I did not have more knowledge and judgement about the cardiovascular risk as it has been cleared by the cardiologist. I spoke to the cardiologist and he was saying that the patient is medically optimized. This hospital does not have any interventional cardiac cath and stenting procedures, in case of cardiac complication We’re to happen to bail us out.</p><p></p><p>I tried to discourage the patient, citing his young age and his high positive family history, patient wAnted to get his ventral hernia fixed as he said it was hurting him and did not want any more cardiac work up.</p><p></p><p>proceeded with an a line and metoprolol for heart rate control and patient did well. Kept him in the hospital overnight as per cardiologist and discharged him. For all this the surgeon complaints to the chief of anesthesia that I delayed the case for 1.5 hours and that I am trying to find reasons not to work and run out the clock.</p><p></p><p>on my part I lashed out at the surgeon and reminded him that if things go bad after he starts the incision that his judgement will also be questioned by my defense lawyers.</p></blockquote><p></p>
[QUOTE="deleted682700, post: 22238063"] I will tell the surgeon to minimize the intraperitoneal pressure during laparoscopy. Only inflate to pressures that you need to get the surgery done quickly. i will put a TEE probe and ask my cardiac anesthesia colleague to stand by. I have had a 48 yr old patient with Positive family history (brother having had Cabg at 52 yrs old and mother had CABG At 65 yrs old. And a positIve stress test For laparoscopic ventral hernia repair. The cardiologist in upstate New York hospital cleared the patient and it was assigned to me ( Locum )anesthesiologist. I talked to the surgeon about the risk and he was adamant that I did not have more knowledge and judgement about the cardiovascular risk as it has been cleared by the cardiologist. I spoke to the cardiologist and he was saying that the patient is medically optimized. This hospital does not have any interventional cardiac cath and stenting procedures, in case of cardiac complication We’re to happen to bail us out. I tried to discourage the patient, citing his young age and his high positive family history, patient wAnted to get his ventral hernia fixed as he said it was hurting him and did not want any more cardiac work up. proceeded with an a line and metoprolol for heart rate control and patient did well. Kept him in the hospital overnight as per cardiologist and discharged him. For all this the surgeon complaints to the chief of anesthesia that I delayed the case for 1.5 hours and that I am trying to find reasons not to work and run out the clock. on my part I lashed out at the surgeon and reminded him that if things go bad after he starts the incision that his judgement will also be questioned by my defense lawyers. [/QUOTE]
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Physician / Resident Forums [ MD / DO ]
Anesthesiology
Positive stress test for non cardiac surgery