When is cancelling trully necessary?

[Chloroform4Life]

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As someone who is committed to become an anesthesiologist and wanting to learn more about the field, I would appreciate hearing about the residents and attendings' experiences regarding cancelled cases. I've seen Jet and other attendings on this forum mentioned how they cancel very few cases and how there are a lot of unnecessary cancellations in academic programs. I want to learn more about when is a cancellation truly necessary and when it is done just because of the status quo. Thanks in advance for sharing.

 

[Narcotized]

As someone who is committed to become an anesthesiologist and wanting to learn more about the field, I would appreciate hearing about the residents and attendings' experiences regarding cancelled cases. I've seen Jet and other attendings on this forum mentioned how they cancel very few cases and how there are a lot of unnecessary cancellations in academic programs. I want to learn more about when is a cancellation truly necessary and when it is done just because of the status quo. Thanks in advance for sharing.

It's pretty straight forward. Cancelling a case is deemed appropriate in any situation in which the patient has already died during surgery; as in, "You're the anesthesiologist, you should have cancelled the case." Many of your surgeons will typically have a fit if you try to cancel a case in pretty much any other circumstance.

 

[usnavdoc]

As someone who is committed to become an anesthesiologist and wanting to learn more about the field, I would appreciate hearing about the residents and attendings' experiences regarding cancelled cases. I've seen Jet and other attendings on this forum mentioned how they cancel very few cases and how there are a lot of unnecessary cancellations in academic programs. I want to learn more about when is a cancellation truly necessary and when it is done just because of the status quo. Thanks in advance for sharing.

I would be wary of generalizations. I've been in academics for almost a year. I do everything except transplant where I work and I haven't canceled anything.

Unless you count the patient having an acute MI in preop scheduled for a Phaco. But I took him in for a Cabg later that day. Nice continuity lol and technically not a cancelation just a lateral transfer from optho to cardiac surg.

 

[rsgillmd]

As someone who is committed to become an anesthesiologist and wanting to learn more about the field, I would appreciate hearing about the residents and attendings' experiences regarding cancelled cases. I've seen Jet and other attendings on this forum mentioned how they cancel very few cases and how there are a lot of unnecessary cancellations in academic programs. I want to learn more about when is a cancellation truly necessary and when it is done just because of the status quo. Thanks in advance for sharing.

No fancy answer: Cancel if you feel the benefits of further workup or medical optimization outweigh the risks and benefits of surgery.

Deciding which side of the risk/benefit scale the patient falls is the part that comes with education and experience.

Also, despite it not being an ABA oral board exam acceptable answer, in clinical practice I still trust my gut. In my view if I have a gut feeling about a situation it is just a subconscious part of my brain that knows the answer but doesn't know how to put into a rational conscious thought process. If I have a negative gut feeling (i.e. I want to cancel a case but can't come up with a good reason to cancel it) I'll tend to consult a colleague.

That having been said many cases don't need to be canceled.

 

[2win]

As someone who is committed to become an anesthesiologist and wanting to learn more about the field, I would appreciate hearing about the residents and attendings' experiences regarding cancelled cases. I've seen Jet and other attendings on this forum mentioned how they cancel very few cases and how there are a lot of unnecessary cancellations in academic programs. I want to learn more about when is a cancellation truly necessary and when it is done just because of the status quo. Thanks in advance for sharing.

I never "cancel" a case.
I optimize the patient OR I refer the patient to another anesthesiologist with more experience than me.
Oh - I bet that my answer is not the one expected - but let me ask you something - did you see patients sent by a surgeon to another one with more experience?
Well - I do the same if I believe so.

 

[RabbMD]

I never "cancel" a case.
I optimize the patient OR I refer the patient to another anesthesiologist with more experience than me.
Oh - I bet that my answer is not the one expected - but let me ask you something - did you see patients sent by a surgeon to another one with more experience?
Well - I do the same if I believe so.

Yep, I never cancel a case. I postpone cases until a patient is either better optimized and/or worked-up, or I tell the surgery than I do not think the patient is appropriate to do at this institution and recommend transferring to a larger hospital (post op ICU care, bipass backup, large possibility of massive transfusion that our blood bank can not adequately service, ect).

 

[bostonblaz]

It depends on the RISK vs the BENEFIT. Also, most important is weather a postponement will actually make the patient better suited for the case. I guess what Jet and other are saying is don't cause an inconvienence for the patient, it's family, and the surgeon just cause you dont want to do the case for some reason such as fear or being lazy. No matter what we think eating nothing after midnight and mentaling preping onesself to get cut open is a huge deal and we should do what we can to make that happen. blaz

 

[loveumms]

As everyone has said, you have to weigh the risk of administering anesthesia (and performing the surgery) versus the benefit of delaying the case to further optimize the patient.

Example: 68 yo male with a hundred medical problems (hypertension, diabetes, COPD, hyperlipidemia just to name a few) presents for elective MRI for hip. Of course, he needs anesthesia because he gets claustrophobic. He tells us on pre-op evaluation that he just found out that his right carotid is 90% occluded and his left is 70%. His pre-op blood pressure was 190/100. We decided it would be safer for him to get worked up by a vascular surgeon for his carotid disease along with better blood pressure control by his PCP before undergoing an elective procedure.