Nurse Anesthetist Clears Unstable Asthmatic Patient For Surgery

ByVictoria Negron

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Updated onAugust 20, 2018

Nurse Anesthetist Clears Unstable Asthmatic Patient For Surgery

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.

Question(s) For Expert Witness

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

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

Expert Witness Response E-127172

inline imageI have 22+ years experience as a CRNA, including working in a level one trauma center for 10 years. I previously served as the associate director of a university nurse anesthesia program. I have anesthetized many asthma patients that were obese and were on steroids. I have taught how to treat asthma patients over the last 12 years and have personally anesthetized these types of patients without incidences. 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 author

Victoria Negron

Victoria Negron

Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.

Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.

Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.

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