How often do you draw the line? - page 2

A few questions. I've read stories of times when the anesthesia provider will cancle or reschedule a surgery based on patient conditions. I'm curious as to how often a situation like this occurs. And I guess I'm wondering, at... Read More

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    Quote from Mully
    Sorry for any miscommunication. I think you all eventually understood what I was asking. Good answers. Very informative.

    The only other question that didn't really get answered was how often does this actually occur. And by "this" i mean, the CRNA deciding he/she won't do a surgery due to patient conditions (in a non-emergent situation). This question, and the entire post really, is directed to the CRNA/SRNA's out there. Thank you!
    A few times a week in our OR (we do about 50 cases a day), the CRNA or anesthesiologist will bring something to the surgeon's attention and the surgeon will cancel/postpone the case. A few times a year the surgeon will want to proceed and anesthesia will not do the anesthetic. We have good rapport with the surgeons so it's uncommon.
    Mully and wtbcrna like this.

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    The anesthesia provider has the final say as to whether they will be providing anesthesia care for a patient. While technically an anesthesia cancellation is cancellation of only the anesthetic, few surgeons will attempt to find another anesthesia provider or put up much of a fight. A surgeon might proceed in some situations however. If a patient is canceled because they ate breakfast and the surgeon feels he can do the case under local then he might go ahead.

    If a patient is canceled for medical reasons a surgeon proceeds at his own risk. These patients are often canceled not only due to the inappropriate risk of an anesthetic, but also the risk of surgery. An example would be a low hematocrit or the patient not having been taken off their blood thinner. Anesthesia itself is not the issue...the actual surgery is...and it is the surgery the anesthesia provider is declaring canceled. Should the surgeon proceed and some untoward event occur, he is in a rather indefensible position. Likewise, should an anesthesia provider proceed with an anesthetic when medically ill advised THEY are at risk for liability. Emergencies are the exception since by definition life or limb is immediately at stake and the case must proceed.

    Cancellations happen on a near daily basis in a busy OR. Whether anesthesiologist or CRNA, the anesthesia provider has the final say as to whether, from their standpoint, a patient will be anesthetized for surgery and they cannot be overruled by ANYONE.
    Mully likes this.
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    Quote from stanman1968
    anesthesia does not cancel cases, they just cancel the anesthetic, if the patient has a comorbidity that will make the anesthetic unsafe or endanger the patient then anesthesia does not have to do the case. It is no diffirent then is a surgeon does not feel a patient is good enough for surgery, not like anesthesia can make them do it.
    In my facility, Anesthesia DOES cancel the case. In my facility, surgeons are notoriously cavalier about their patient's general health and readiness for anesthesia and the procedure.

    If Anesthesia cancels, the case is cancelled. And it happens routinely, 2-4 times weekly.
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    Quote from Whispera
    Also, the anesthesiologist monitors how long the patient has been "under" and will hurry the surgeons along...
    In the 19 years I've been practicing anesthesia, I've never "hurried the surgeon along." I am not a surgeon and cannot and will not tell them how to do their job and they do not tell me how to do my anesthetic. We provide anesthesia for as long as necessary. We certainly communicate a patient's status to the surgeon and if that makes them finish sooner rather than later, that's the surgeon's decision, not ours.
    dissent and foraneman like this.


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