Unaware of Intubation

[GMO2003]

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I'm hoping an anesthesiologist can help shed some insight into this situation.

So my wife had a routine outpatient procedure. Apparently, the anesthesiologist that was taking care of her informed her that she would be receiving regional or local anesthesia only for the procedure along with some versed.

She awoke from the procedure spitting up blood and it turns out that an airway was placed during the procedure. I assume the airway was placed electively by the anesthesiologist as a precaution to maintain the airway during the procedure.

If so:

1) The anesthesia provider never told my wife they would place an airway if they thought it would be clinically necessary. I understand in cases of emergency this would be absolutely necessary. This was not the case. It was obviously placed electively by the anesthesia provider without first telling her that it would be a possibility during the procedure.

2) They explicitly told her that the procedure would be done under regional or local anesthesia only. There was absolutely no mention of the possibility of an airway at all.

Is this the standard of care in terms of educating and communicating with the patient?

 

[deleted126335]

Regional blocks fail, patients react badly to sedation or other meds, have anxiety attacks, the operative procedure may become more extensive than originally planned, etc. It is not at all that uncommon to intubate or place an LMA that I didn't expect to need. The "spitting up some blood" may be from an oral or nasal airway as well as the more invasive endotracheal tube or LMA.

I don't routinely tell patients preoperatively that I may need to convert to a general anesthetic or place an airway device unless I have a high index of suspicion that I might need to. Intraoperatively, I tell them what I need to do, however, at this point they have very likely received a good amount of sedative drugs that have amnestic properties. Versed has this property. So it is not uncommon to have no recollection of being counseled.

 

[Planktonmd]

I'm hoping an anesthesiologist can help shed some insight into this situation.

So my wife had a routine outpatient procedure. Apparently, the anesthesiologist that was taking care of her informed her that she would be receiving regional or local anesthesia only for the procedure along with some versed.

She awoke from the procedure spitting up blood and it turns out that an airway was placed during the procedure. I assume the airway was placed electively by the anesthesiologist as a precaution to maintain the airway during the procedure.

If so:

1) The anesthesia provider never told my wife they would place an airway if they thought it would be clinically necessary. I understand in cases of emergency this would be absolutely necessary. This was not the case. It was obviously placed electively by the anesthesia provider without first telling her that it would be a possibility during the procedure.

2) They explicitly told her that the procedure would be done under regional or local anesthesia only. There was absolutely no mention of the possibility of an airway at all.

Is this the standard of care in terms of educating and communicating with the patient?

Every patient who goes to the OR for any procedure under regional or local anesthesia is usually consented to General anesthesia as well because there are times when the regional or local anesthetic might not be adequate and a deeper level of anesthesia is required.
If you look at the consents that your wife signed you will most likely find that she consented to all necessary anesthetic techniques.

 

[Colba55o]

You and your wife should contact her anesthesiologist so he/she can explain what happened rather than asking people here who have no idea what happened during the case. I'm sure the anesthesiologist did not place an airway just for kicks or out of spite.

Btw I'm glad (as I'm sure your anesthesiologist is also) that your wife made it through the procedure ok.

 

[GMO2003]

Thanks for the professional insight...it make sense

I'm not an anesthesiologist. However, why not just tell the patient that a possible airway will be placed in the event the anesthesiologist deems it clinically necessary.

In this case, it wasn't done and it created unnecessary confusion and anxiety after the procedure for the patient.

Simple request. Nonetheless, something that would put a lot of patients at ease even for the most routine of procedures.

 

[deleted171991]

1) The anesthesia provider never told my wife they would place an airway if they thought it would be clinically necessary. I understand in cases of emergency this would be absolutely necessary. This was not the case. It was obviously placed electively by the anesthesia provider without first telling her that it would be a possibility during the procedure.

If it was an UNPLANNED intubation in the OR, then it was probably not ELECTIVE, unless the surgery hadn't started yet. For some reason, the anesthesiologist had to switch to general anesthesia. Have you asked him/her why? Most probably it was either surgeon- or patient-related, definitely not the anesthesiologist's "elective" choice.

2) They explicitly told her that the procedure would be done under regional or local anesthesia only. There was absolutely no mention of the possibility of an airway at all.

Probably because all that surgeon needs 99.9% of the time, in their experience, is local/regional. In situations like that, it's debatable whether to bring up general anesthesia in the discussion (many patients become anxious, because their surgeon had never mentioned even the remote possibility in the office, and the anesthesiologist is the bad guy who uselessly scares the patient). Damned if you do, damned if you don't. Actually, it is MUCH easier for us to bring up all the infrequent complications, because that's the newest weapon for malpractice attorneys.

I personally had a situation like this recently. I usually don't tell my patients about general, unless there is a good chance for it. That day, I was working with one of the best surgeons I know, and we were doing some minor breast procedure. Interestingly, I almost never mention backup with general for her patients, but in this case I did. (The case was not booked under general, but under local with monitored anesthesia care.) Guess what? She enters the OR, looks at the patient already sleeping peacefully on propofol and says: "I need general. It's a deeper lesion than I thought." She never told me outside, never mentioned it to the patient when she marked the surgical site 15 minutes earlier.

Hindsight is always 20/20. As long as all your wife got was some minor throat injury (happens to the best of us), I would say thanks to that anesthesiologist for taking care of her.

 

[Colba55o]

Hard to believe the OP is an Attending Physician.
If you had a patient that was left with questions about the care you provided, wouldn't you prefer they bring up the questions they had with you rather than seeking insight from a message board? Not only will you get some answers but you may provide the physician with some feedback that might actually be helpful.

No one here knows why your anesthesiologist did what they did, we can only speculate with incomplete information.
I get the impression you are trying to make a point or be a troll but its hard to decide.

 

[pgg]

Per SDN's terms of service, these forums are not the place to get medical advice or second opinions.

If you have concerns about the care you or a family member received during surgery, you should discuss it with your anesthesiologist or another physician.

Closing.