Case 44: Anesthesia for a Surgeon Who Has Previously Lost His Privileges

Abstract

You have just completed residency and have joined an anesthesia group that has many surgical locations to cover. Today you are assigned to a free-standing surgical clinic. This is your first time in this clinic. Your first case is a 42-year-old male who is a drug abuser and positive for HIV. According to the surgical history and physical exam, he is otherwise healthy. He is scheduled for a cervical discectomy under MAC (monitored anesthesia care). Upon arrival at the clinic, you introduce yourself to the head nurse. She tells you that the surgeon always does these cases under MAC and has refused in the past to have them done under general anesthesia. You look at the operating room list and discover that this is (fortunately) the only case he is doing today. You arrive in the change room, and one of your anesthesia colleagues tells you that the surgeon you are working with today has lost his privileges in many hospitals and clinics in the area. He also lost his privileges in the one you are in now but has recently been reinstated. This is his first time back after a 12-month absence. You ask why he lost his privileges in this clinic, and you are told that he punctured the trachea in one patient during a cervical discectomy under MAC. This led, in the postoperative period, to severe surgical emphysema of the neck with obstruction of the airway. Even though he was aware that the patient had breathing difficulty due to surgical emphysema in the postoperative period, he did nothing and left the hospital. The patient stopped breathing 30 min later. Without the timely intervention by an anesthesiologist, who was passing by in the recovery room, the patient would have died. Adding to your concern is the fact that you are told by your anesthesia colleague that the surgeon told the patient to sue the anesthesiologist as it was his fault. You are now really apprehensive and wonder what you should do.