Abstract
A middle aged woman was scheduled for supracervical lymph node biopsy under local anesthesia. A scheduling conflict caused a significant operating room delay and she became very nervous. A surgical resident asked for anesthetic assistance in calming the patient. Assured that the case was under local anesthesia only, the anesthesiologist gave the patient soda to drink. In the operating room, the lady could not tolerate the procedure but as she now was at risk for aspiration, the anesthesiologist suggested the case be terminated and rescheduled. The surgeon disagreed and continued but was confronted with substantial bleeding. Emergency induction of general anesthesia was required. Postoperatively bleeding continued requiring re-exploration and intensive care unit admission. The patient developed a compressive left brachial plexopathy. The anatomy of the area indicated that general anesthesia was the preferred technique. The importance of team work and communication is underscored. Complications are more frequent when perioperative changes are made.
Highlights
All too often in a busy practice, a surgeon’s preference may be to operate using only local anesthesia, believing that time might thereby be shortened
The anesthesiologist explained that the patient was no longer fasted, she had not been interviewed for an appropriate preanesthetic assessment and if the surgical team was not able to accomplish the procedure under local anesthesia, the case should be aborted and rescheduled with anesthesia assistance at a later date
What are the indications for scheduling a case such as this under local anesthesia versus with anesthetic assistance? Second, does the anatomy of the supracervical region offer any suggestions as to choice of the safest management course? Third, what complications might be expected from surgery in this region?
Summary
All too often in a busy practice, a surgeon’s preference may be to operate using only local anesthesia, believing that time might thereby be shortened. The preceding case in the operating room had been delayed significantly and instead of the assigned time of 12:00, the patient was still in the waiting room at 16:30 She was anxious and distressed and the senior surgical resident asked for advice and some guidance. After verifying with the surgical resident that the procedure was to be accomplished under local anesthesia, the anesthesiologist offered her a diet drink She accepted, moved to a chair and seemed relieved. The anesthesiologist explained that the patient was no longer fasted, she had not been interviewed for an appropriate preanesthetic assessment and if the surgical team was not able to accomplish the procedure under local anesthesia, the case should be aborted and rescheduled with anesthesia assistance at a later date. A review of the surgical specimen revealed fibrous tissue with no lymphoid tissue in the sample
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