ABSTRACT
UNLABELLED: Cardiology consultations are often requested by surgeons and anesthesiologists for patients with cardiovascular disease. There can be confusion, however, regarding both the reasons for a consultation and their effect on patient management. This study was designed to determine the attitudes of physicians toward preoperative cardiology consultations and to assess the effect of such consultations on perioperative management. A multiple-choice survey regarding the purposes and utility of cardiology consultations was sent to randomly selected New York metropolitan area anesthesiologists, surgeons, and cardiologists. In addition, the charts of 55 consecutive patients aged >50 yr who received preoperative cardiology consultations were examined to determine the stated purpose of the consult, recommendations made, and concordance by surgeons and anesthesiologists with cardiologists' recommendations. Of the 400 surveys sent to each specialty, 192 were returned from anesthesiologists, 113 were returned from surgeons, and 129 were returned from cardiologists. There was substantial disagreement on the importance and purposes of a cardiology consult: intraoperative monitoring, "clearing the patient for surgery," and advising as to the safest type of anesthesia were regarded as important by most cardiologists and surgeons but as unimportant by anesthesiologists (all P < 0.05). Most surgeons (80.2%) felt obligated to follow a cardiologist's recommendations, whereas few anesthesiologists (16.6%) felt so obligated (P < 0.05). The most commonly stated purpose of the 55 cardiology consultations examined was "preoperative evaluation." Only 5 of these (9%) were obtained for patients in whom there was a new finding. Of the cardiology consultations, 40% contained no recommendations other than "proceed with case," "cleared for surgery," or "continue current medications." Recommendations regarding intraoperative monitoring or cardiac medications were largely ignored. IMPLICATIONS: We conclude that there seems to be considerable disagreement among anesthesiologists, cardiologists, and surgeons as to the purposes and utility of cardiology consultations. A review of 55 consecutive cardiology consultations suggests that most of them give little advice that truly affects management.
Subject(s)
Anesthesiology , Attitude of Health Personnel , Cardiology , General Surgery , Preoperative Care , Referral and Consultation , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Data Collection , Female , Humans , Male , Middle AgedSubject(s)
Nitroglycerin/therapeutic use , Obstetric Labor Complications/drug therapy , Uterine Diseases/drug therapy , Adult , Anesthesia, Epidural , Anesthesia, Obstetrical , Anesthetics, Dissociative/administration & dosage , Anesthetics, Local/administration & dosage , Female , Humans , Injections, Intravenous , Ketamine/administration & dosage , Nitroglycerin/administration & dosage , Pregnancy , Procaine/administration & dosage , Procaine/analogs & derivatives , Uterus/drug effectsABSTRACT
A 20-yr-old primigravida at 38 weeks gestation with premature rupture of membranes and evidence of fetal distress required urgent Caesarean section. The diagnosis of osteogenesis imperfecta had been made 4 days earlier. The patient refused a regional anaesthetic. Difficulties in the administration of general anaesthesia to patients with osteogenesis imperfecta were recognized and managed accordingly. These problems are discussed and the importance of early antenatal assessment of such patients by the department of anaesthesia is emphasized.
