What are some of the bad things that can go wrong?

[cyclicamp]

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Besides malignant hyperthermia, what are some of the catastrophies that an anesthesiologist must be ready to deal with? Particularly what are major considerations when dealing with the patient who has endocrinological, cardiovascular, pulmonary, oncological, or genetic disease?

 

[undecided05]

Surgeons... j/k Lots of bleeding, BP problems, electrolytes, especially blood sugar management in poorly controlled diabetics, respiratory problems (getting people off the vent) especailly for smokers, peculiar diseases (pheochromocytomas). Patient pathology in general. Sorry if this is broad based or not what you were looking for.

 

[Justin4563]

The most important task that an anesthesiologist must not screw up is the airway. People with difficult airways are the most challenging to deal with.. ALso massive blood loss and its implications, Myocardial infarction and coronary artery disease are challenging. Valvular abnormalities in particular aortic stenosis with a very high gradient across the valve.

Embolus'; pulmonary, fat, and amniotic fluid,
fetal distress in preeclamptic patients are very challenging to deal with
parturients who have coagulation issues...

this is a small list... there are so many...........

 

[Skip Intro]

Besides malignant hyperthermia, what are some of the catastrophies that an anesthesiologist must be ready to deal with? Particularly what are major considerations when dealing with the patient who has endocrinological, cardiovascular, pulmonary, oncological, or genetic disease?

In addition to those above, a fairly common one I saw (and one that made one anesthesiologist sweat-out his scrubs in one occassion) was refractory hypotension that didn't immediately respond to pressors. In this case, the patient's blood pressure was about 50/30 for a solid twenty minutes. The complication that made them doo-doo in their pants was anoxic brain injury due to hypopefusion.

Also, they are extremely vigilant about patient positioning. The catastrophe is that you have a long case where the patient is malpositioned, and then they wake-up with some palsy in an extremity. Next thing you know, you're in court trying to explain why grandpa could walk before his surgery but now is restricted to a wheelchair because he's lost all feeling in one leg. This is one of those scary, hidden catastrophes that you can't possibly know about until the patient wakes up. Hence, they always double (and sometimes triple) check when the surgeon asks them to move the bed.

-Skip

 

[seaofred]

Well, since we are on the subject I will tell my story that just happened 3 hours ago.... So I am finishing up a plastics case that we did with an LMA in place and the patient spontaneously breathing. I have a CA1 in my room and all of a sudden there is no CO2 on the capnogram... I try to give a positive pressure breath and I am unable to ventilate. Thinking that the patient is light, I give 100mg of propofol, wait a few seconds and still can't give positive pressure breath.... I yank out the LMA, put an oral airway and try to give some positive pressure through a mask.. Still no ventilation...(Background music is the sats starting to fall). I grab my MAC4, 7.5 tube push sux). Cords are together for DL but relaxed shortly and the patient was intubated. I look up and I see the sats in the 30s. A few breaths later sats return to normal.
I had been pretty lucky with not having very many sphincter tightening experiences during my first 2 years, I guess that anesthesia gods want to make my CA3 year more exciting.