Nurse Anesthetist Clears Unstable Asthmatic Patient For Surgery

Case Overview

This case involves a 35-year-old male patient with a history of low platelet levels who underwent a splenectomy. The patient had a past medical history of obesity and asthma for which he was receiving high dose steroids and immunoglobulins. The patient had an abnormal preoperative chest x-ray which was interpreted as a partial lung collapse. The patient underwent general endotracheal anesthesia with a thoracic epidural. During the procedure, the patient lost the CO2 waveform and suffered from oxygen desaturation. A code was called. The patient subsequently underwent multi-organ failure and died. It was alleged that the attending nurse anesthetist (CRNA) failed to maintain the patient’s steroid regimen and failed to take his comorbidities into consideration when clearing him for anesthesia during the surgery.

Questions to the Nursing expert and their responses

How frequently do you anesthetize patients like the one described in this case (obese, on steroids with asthma)?

I have 22+ years experience as a CRNA, including working in a level one trauma center for 10 years. I have anesthetized many asthma patients that were obese and were on steroids.

What factors should be taken into consideration preoperatively/intraoperatively for a patient with these comorbidities?

The evaluation of patients with asthma requires an assessment of the disease severity. This includes knowing the use of bronchodilators and the effectiveness of all their current pharmacologic management. Also, it is important to know the frequency of emergency room visits, the occurrence of hospitalization, and if tracheal intubation was ever needed. For a patient with severe asthma, a pulmonary consult (or a consultation with the patient's pulmonologist) should be required to ensure the patient is at their optimum condition for treatment and to receive any additional treatment recommendations the day of surgery. The goal during induction and maintenance of general anesthesia in patients with asthma is to depress airway reflexes and avoid bronchoconstriction in response to mechanical stimulation of the airway. There are many techniques to achieve this standard.

About the expert

This highly qualified expert has been a practicing CRNA for the past 17 years. He received a bachelor's and master's degree in nursing from Kent State University and the University of Akron, respectively. He then went on to receive his doctorate in nursing practice from the prestigious Case Western University Medical Center. He has clinically active as a CRNA at a large community hospital and director of the CRNA program at a large nursing school in the Midwest.