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A question for my elders:
Let's say you have a patient who is about to undergo eye surgery.
Now, cataracts and retinopathy don't tend to happen in young, healthy people. They tend to occur in the elderly, as well as those with multiple medical problems including HTN, CAD, DM, PVD, CRI, etc. Furthermore, these patients are usually frail, deconditioned, obese, +/- in wheelchairs and with truly marginal functional status (i.e. ASA 3+).
And the gist of the anesthetic typically consists of the surgeon placing a retrobulbar block under "MAC" (but realistically, a few minutes of general anesthesia because God-forbid they move during the block).
How extensive should their pre-op assessment be?
On the one hand, their vision is at stake and thus so is their quality of life. And besides, it's minimally invasive surgery with no blood loss or fluid shifts. Will you go ahead and put them under with enough propofol to render them motionless so the surgeon can place his block, and then apply jaw thrust until they wake up, all the while hoping that they don't desaturate too much, or for too long?
On the other hand, surgery and anesthesia are stress tests unto themselves. Do you delay surgery in order to get further tests or cardiac workup or refer them to their primary care docs or cardiologists for further medical optimization?
Thanks in advance,
Let's say you have a patient who is about to undergo eye surgery.
Now, cataracts and retinopathy don't tend to happen in young, healthy people. They tend to occur in the elderly, as well as those with multiple medical problems including HTN, CAD, DM, PVD, CRI, etc. Furthermore, these patients are usually frail, deconditioned, obese, +/- in wheelchairs and with truly marginal functional status (i.e. ASA 3+).
And the gist of the anesthetic typically consists of the surgeon placing a retrobulbar block under "MAC" (but realistically, a few minutes of general anesthesia because God-forbid they move during the block).
How extensive should their pre-op assessment be?
On the one hand, their vision is at stake and thus so is their quality of life. And besides, it's minimally invasive surgery with no blood loss or fluid shifts. Will you go ahead and put them under with enough propofol to render them motionless so the surgeon can place his block, and then apply jaw thrust until they wake up, all the while hoping that they don't desaturate too much, or for too long?
On the other hand, surgery and anesthesia are stress tests unto themselves. Do you delay surgery in order to get further tests or cardiac workup or refer them to their primary care docs or cardiologists for further medical optimization?
Thanks in advance,
