Volume 3, No. 4 • Winter 1988

Questions Raised About Leaving Patient During Competing Emergency

Miguel Figueroa, Jr., M.D.

To the Editor

I read with great interest pages 14 and 15 of the June, 1988 issue of the APSF Newsletter.

On page 14, Drs. Howard Zauder and Joanne Jenne answer the question as to “when, if ever, is it appropriate for an anesthesiologist to step outside the OR door for brief periods… etc?” On page IS there is a letter from a Risk Manager in a Massachusetts hospital regarding the practice of allowing Post-Anesthesia Care Unit Nurses to Extubate patients.

Drs. Zauder and Jenne are very emphatic about the fact that it is never appropriate for the anesthesiologist to leave an anesthetized patient for any reason unless replaced by an appropriate substitute. The writer from Massachusetts questioned the practice of PACU Nurses extubating patients in the recovery room.

The following incident recently took place in one of our hospitals. I have changed the names of the patients to ensure confidentiality. I would like to hear comments from Drs. Zauder and Jenne The scenario was as follows:

About 3:00 P.M., two anesthesiologists were finishing a days’ work in a Single Day Surgical Facility myself and one of my associates.

In one room I was giving Monitored Anesthesia Care to a patient named “Jenne” for a cataract extraction. Mrs. Jenne was slightly sedated but awake and perfectly calm even trying to talk whenever she was allowed. In the other room a patient named “Pierce” was undergoing a laparoscopy under general endotracheal anesthesia with controlled ventilation. AU was relatively quiet until a call came from the recovery room that a patient named “Zauder” was experiencing some respiratory obstruction after having been extubated by very experienced recovery room nurses. Mr. Zauder had undergone a knee arthroscopy under general endotracheal anesthesia and had been taken to the recovery room breathing spontaneously but still intubated.

Since my associate in the next room couldn’t really leave his patient with an “appropriate substitute”, I asked my surgeon if I could leave Mrs. Jenne, who was actually awake and very stable, in the care of the circulating nurse, and go to the recovery room to do whatever I could to save Mr. Zauder’s life. Actually, even Mrs. Jenne herself, although under the influence of sedatives, agreed I should go see what was wrong. I rushed to Mr. Zauder’s side, applied some positive pressure ventilation, re-intubated him and returned to the care of Mrs. Jenne, fully confident that I had acted appropriately.

To this day, I believe I would do the same thing under the same circumstances. However, after reading the last APSF Newletter, I am beginning to wonder if it was proper to save Zauder’s life in the recovery room when I really should have remained with Mrs. Jenne as long as she was in the operating room.

Please advise

Miguel Figueroa, Jr., M.D. North Miami Beach, FL