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Anesthesia

Pre-Anesthesia Interview

03/24/2009

Question:

I have learned a lot from your responses, and I`m becoming more comfortable with the idea of anesthesia for my upcoming complete tummy-tuck. The surgeon has been great; she has answered all of my questions in detail about the procedure, which she says will take several hours. Unfortunately, she could tell me little about the anesthesia and referred me to the staff anesthesiologist. When I tried to arrange a meeting with him, I was reminded that his fee would be due in advance (not a problem since it`s out of pocket cosmetic surgery), but what bothered me was that he didn`t want to answer any questions about the surgical anesthesia, and my wife and I had some. We made an appointment to meet with him, but a nurse told us that he would only see me just before surgery. I then asked if he (a physician) would be performing the anesthesia himself or would it be a CRNA (they cost me the same, so it`s natural to want a physician, right?) and I was told that I would get whomever was next on the list for my surgery, it might be a nurse, a physician or some combination thereof. I realize that you can`t answer speciic questions, but in general, does this sound correct? I have had other outpatient surgeries elsewhere and anesthesia always bent over backwards to answer questions. We have 2 friends who have had the same procedure and both had violent post-op nausea and vomiting which drugs did not help. My wife, a nurse (not a CRNA) tried to ask if they could do IV anesthesia in addition to the local that the surgeon would be doing; the nurse told us that she didn`t know and to ask on the day of surgery. As we were leaving, the anesthesiologist, briefed by the nurse came over and basically berated us for asking questions and told us that I would get whomever was available and receive whatever anesthesia they wanted to give, then he walked out. Last night, we got a pre-op call from a nurse (surgery was scheduled for this morning) and we again tried to ask a few questions, which she couldn`t answer. She told me that someone from anesthesia would call me back, but nobody did. Then, this morning, at the surgery center, we waited in a room for a long time for someone from anesthesia, no luck until 5 minutes before the scheduled time when no fewer than 2 CRNAs and the anesthesiologist came in imploring me to "hurry up", let us get started to "make you comfy". Again, no time for questions. Needless to say, no surgery a done. I know that you can`t comment specifically, but in general: is it unreasonable to want to know who is doing (or at least in charge of) your anesthesia and to have questions answered beforehand? thanks

Answer:

Thanks for sharing your experience.

I certainly don't blame you for walking away from your surgery. The anesthesiologists and CRNAs you encountered may be highly technically competent individuals. However the responses you received to your request for information speak to a different aspect - professionalism - on which they would not rate very highly.

Every person undergoing anesthesia has the right to a full discussion about the risks, benefits and alternatives to the chosen anesthetic technique. You are also entitled to know who is taking care of you, what their roles are, and even their qualifications to do so. Finally you are entitled to ask about costs, especially in an era when people in the US are expected to pay more and more out of pocket for their healthcare. Some people may be offended by such questions, but that's their problem, not yours.

Such a discussion can't easily take place 5 minutes before the surgical procedure. Unfortunately this tends to be standard practice in many, perhaps most, surgical centers. Solutions to this problem include online patient interviewing and education systems, and anesthesia preoperative clinics.

I can't think of a good excuse for why the anesthesia staff were not prepared to talk to you. It may not be possible to offer detailed discussion to ALL patients, and continue to run busy operating rooms, but when a patient specifically requests information I believe most of us would bend over backwards to accommodate. Good luck finding better service in a different location.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University