waking anesthestized patient

[akor]

Hi....have another question.....have you ever seen the decision to wake up a patient before the surgery started to do an emergency case? I have seen them wake up an anesthetized scheduled cardiac patient to do an aortic dissection emergency case.

thanks for the replies...

[CRNA, DNSc]

Yes that was a logical move if the institution did not have the capacity to run 2 major rooms at that same time. Aortic dissection is a time critical case that can not wait- seconds/minutes can mean the difference between life and death. Elective Cardiac surgical case is still elective- it might be inconvenient for the cardiac patient but that case can be done later- the aortic dissection can't wait!!!!

[passionate]

I agree. If the patient is anesthestized that is a reversal option. Not doing an emergent dissection is no option at all!

[BloodNGuts]

What she said.

[jwk]

Yes that was a logical move if the institution did not have the capacity to run 2 major rooms at that same time. Aortic dissection is a time critical case that can not wait- seconds/minutes can mean the difference between life and death. Elective Cardiac surgical case is still elective- it might be inconvenient for the cardiac patient but that case can be done later- the aortic dissection can't wait!!!!

Sorry, I've got a different take on this one. This would never happen in our facility.

The stress of anesthesia, especially induction and intubation, is not an inconsequential event, particularly in a cardiac patient. If a patient has already been anesthetized, the surgery proceeds. If your facility does not have the capability of running two critical procedures at the same time, it shouldn't even consider doing the first one.

There are often times that bad things happen because of timing. You're in the middle of an elective C-Section with your only OR team, a mom prolapses a cord, and you have to wait for the call team to come in. You don't stop in the middle of the first case to do the second.

[passionate]

While I agree that you don't stop in the middle of a case I still stand by my orgiinal statement of waking a patient to do an aortic dissection if indeed the incision has not been made. The circulator and scrub isn't the only part of the team, anesthesid, pediatrician, OB, RT, lots of folks are involved in the scenerio presented by jwk--looking at a scenerio is not the same as being in the moment of decisions presented. I am glad I don't have to make those calls--ever.

[GadgetRN71, ASN, RN]

Sorry, I've got a different take on this one. This would never happen in our facility.

The stress of anesthesia, especially induction and intubation, is not an inconsequential event, particularly in a cardiac patient. If a patient has already been anesthetized, the surgery proceeds. If your facility does not have the capability of running two critical procedures at the same time, it shouldn't even consider doing the first one.

There are often times that bad things happen because of timing. You're in the middle of an elective C-Section with your only OR team, a mom prolapses a cord, and you have to wait for the call team to come in. You don't stop in the middle of the first case to do the second.

I was going to say that I have never seen this happen in any of the hospitals where I have worked, even on off shifts or on call. I have seen cases get bumped before the patient is in the room. If a case was going on, then we start calling people in( we have a disaster list).

[gallacher2001]

We operate in a department that has 16 elective theatres and 2 dedicated emergency theatres and one trauma orthapedic theatre, so I have to say that fortunately we have never had to reverse an anaesthetic to do an emergency, cancelled lists before and bumped patients from lists but never reversed!

[kukukajoo, LPN]

Sounds to me that they needed the surgeons and not the room to do the Aortic Dissection case. Very few places do this type of surgery and fewer surgeons as well.

I agree, this was a priority case and with a personal view- my kids dad almost died from a huge aortic dissection and rupture. Thankfully her was life flighted to a trauma center that pioneered this surgery and had amazing surgeons and God on his side.

SECONDS can mean the difference between life and death.

I vote for waking the pt and getting the dissection done.