Download - SAYING “NO” WHEN IT IS IMPORTANT
SAYING “NO” WHEN IT IS
IMPORTANT
DR.S.N.KRISHNAMOORTHYM.D., D.A., D.N.B., B.G.L., P.G.D.M.L.E.,
SAYING “NO”
• Medical profession is a noble profession wedded to service and sacrifice.
• Its services are available to all regardless of extraneous considerations.
Saying “No”
• Denial of anaesthesia services is justified if actuated by noble and laudable objectives of averting anaesthesia related complications which are anticipated
SAYING “NO” IN ANAESTHESIOLOGY
• The decision to say “No” is based on the clinical facts and circumstances of the case.
WHY THE OCCASIONAL NEGATIVE APPROACH?
1. Anaesthesiologist always works as part of a team.
– Deficiencies of other team members impinges on anaesthetic management and enhances risks and complications.
• The Operation Theatre is always in the control or possession of the surgeon.
• Surgical needs are very well taken care of .
• Anaesthesia requirements may suffer neglect.
• Minor deficiencies in the anaesthesia set up have the potential to cause serious complications.
WHY THE OCCASIONAL NEGATIVE APPROACH?
• In the event of intra-operative mishaps, anaesthetist finds himself in a very weak position.
• Often, dishonestly drawn into the medico-legal muddle.
WHY THE OCCASIONAL NEGATIVE APPROACH?
• No opportunity to develop rapport with the patient
• Mostly unknown to patients, a thankless job – though crucial and life-saving.
WHY THE OCCASIONAL NEGATIVE APPROACH?
SAYING “NO”
CLINICAL SITUATIONS>>
ANAESTHESIA WITHOUT PRE-ANAESTHETIC EXAMINATION OF PATIENT / AIRWAY
• Common clinical situation in emergency surgery especially obstetrics.
• Unexpected clinical/technical problems
Lack of preparedness leads to disaster.• Even in the worst emergency, pre-anaesthetic
evaluation is a must.
GA IN A PAEDIATRIC PATIENT WITH ACUTE RESPIRATORY INFECTION
• Acutely inflamed respiratory passages.
• Instrumentation leads to high incidence of bronchospasm / laryngospasm.
• Completely avoidable.
GA IN ACUTE RESPIRATORY INFECTION
• IT IS ON THE PATENCY OF THE BRONCHIOLAR
LUMEN AND QUIESCENE OF RESPIRATORY
REFLEXES THAT SMOOTH GENERAL ANAESTHESIA
DEPENDS - NOSWORTHY
PATIENT “UNFIT” FOR ANAESTHESIA
• Multiple severe & uncorrected physiological derangements and multi-system disorders.
• Co-existing Anaesthetic problems
• Meddlesome anaesthesia
Patient unfit for anaesthesia
• Anaesthesia is a double-edged sword; capable of conferring great benefits to mankind if applied properly.
• It can also do great harm if applied by or to the wrong person
Denial of anaesthesia services
• Chloroform has done a lot of mischief; it has enabled every fool to become a surgeon – George Bernard Shaw in “Doctor’s dilemma”.
ANAESTHESIA FOR PARTIAL RESPIRATORY OBSTRUCTION
• Patients are restless and un-cooperative
• Anaesthesiologist is called upon to ‘sedate’ or ‘quieten’ the patient for the procedure.
• Administration of CNS depressants/muscle relaxants is dangerous
DIFFICULT AIRWAY SITUATION WITHOUT AIRWAY GADGETS
• Many airway gadgets are available today
• Blind techniques with false hopes of successful intubation is unacceptable.
• Airway management is the exclusive responsibility of anaesthetist.
LACK OF BASIC MONITORS/INVESTIGATION
• Deficiencies in the anaesthesia setup should not be condoned but corrected.
• Alternatively, their implications should be discussed and consent secured.
• Safety of anaesthesia is paramount.
WHAT IF YOU DO NOT SAY NO?
• Dr.Minaxiben V. Aruna Kothari, Ahmedabad.[Gujarat State Consumer Disputes Redressal Commission, Ahmedabad; complaint No; 77 of 1993. decided on 6/8/1996.
• Known cardiac patient with unstable cardiac rhythm given general anaesthesia for an orthopaedic surgery in the right upper limb.
• Patient developed ventricular fibrillation; could not be resuscitated for want of defibrillator in the O.T.
WHAT IF YOU DID NOT SAY “NO”
GUJARAT STATE CONSUMER COMMISSION
• “She should have procured the same as a precaution before starting anaesthesia OR
• could have refused to give anaesthesia without the said machine OR
• she should have brought these facts to the notice of patient’s relative which unfortunately she did not
“CRIMINAL NEGLIGENCE”
*Indifference to an obvious risk
**Actual foresight of the risk with determination nevertheless to run it
***Appreciation of the risk with attempted avoidance weak
****Inattention to a serious risk which goes beyond ordinary negligence
CONCLUSIONS
• “LURE OF THE LUCRE” should not lead us astray.
• Anaesthesia practice should at all times be patient-centric; it should NEVER be surgeon-centric.
• Say “No” to all avoidable risks.
• Safety of anaesthesia is supreme and paramount.
THANK YOU!