One of the hallmark characteristics of anesthesia provision is vigilance. The best anesthesiologists are extremely vigilant and continuously aware during the provision of anesthesia for any patient. It may seem odd that this would be the case given the tremendous technology currently available and used for anesthesia administration;
anesthesia monitors provide accurate and continuous information about the patient such as oxygen delivery and saturation medical devices that allow the detection and amplification of breathing sounds by the patient equipment and supplies that can specifically deliver medications to the patient over a determined course of time
So…with this state of the art technology, why doesn’t the anesthesiologist just sit back and let the patient go on cruise control? Because of the unexpected!
The bottom line is that people come in a variety of shapes, sizes and types and because of this variety, people are unpredictable. And because people are unpredictable, the unexpected can happen at any time. Even though we have the best monitors, equipment and supplies available to us when administering anesthesia, these things are merely assistants to us as anesthesiologists as they provide us with information to help guide and assist our decisions and responses to our patients when things change.
So, to rely only on our monitors and other equipment would be doing a disservice to our patients. We must be vigilant practitioners when caring for our patients so that we are ever prepared for the unexpected that can occur at any time and for any reason.
It is the obligation and primary duty of our practice to be fully prepared for the anesthesia services we provide for your patients. When the unexpected happens we can respond rapidly to resolve the situation quickly. This is our commitment and responsibility to provide the best level of service for you and your patients.
Dear Mr. Smith: (All names changed,)
As you know, I saw your son on 11 November at Dr. Austin Curios office. As we discussed prior to the procedure, Johnny has a history of large tonsils with associated “loud snoring” at night. You reported that he has never had any type of surgery or procedure to address this situation though his physician is aware of his history.
I placed Johnny under general anesthesia for his dental treatment with Dr. Curios. Shortly after the induction of anesthesia he obstructed and was not moving air between his mouth and lungs. Further evaluation revealed that he was not breathing through his nose either. Direct laryngoscopy was performed revealing very large tonsils that were not only in contact with each other, but also displaced anteriorly. This situation was corrected by placing a nasal airway and he successfully tolerated the procedure and anesthesia without complication.
My evaluation also revealed the presence of upper chest depression similar to a funnel chest possibly suggesting a chronic situation where significant negative pressure is created during breathing due to obstruction. This obstruction is very likely due to the size of his tonsils and possibly his adenoids are involved as well.
I would strongly encourage you to follow-up with his physician to determine the necessity of removing his tonsils and/or adenoids to aid in the relief of his breathing difficulty.
Please feel free to contact me if you have any further questions or concerns.
Anthony Charles Caputo, DDS, PC