Change in Plans

Occasionally, surgeries do not go as smoothly as planned, and as anesthesiologists, we have to adapt to changing circumstances. I had two cases that were converted from a minimally invasive strategy to an open one. In the first, the surgeons were attempting to do a distal pancreatectomy with a surgical robot. Despite the improved dexterity and manipulation offered by the robot, the patient's organs had too much adipose tissue to allow the surgeons to dissect effectively. After a few hours of struggling, the attending surgeon decided to open the patient. This is not an easy decision as it exposes the patient to a longer hospital stay, more post-op complications, and more pain. In an open fashion, they were able to resect the distal pancreas in just an additional hour. Since the amount of time under anesthesia and in surgery is also correlated with outcomes, it becomes a balancing act of risks and benefits in deciding when to change plans. Similarly, I was in a case where the surgeons initially tried to do a laparoscopic sigmoid colectomy, but eventually had to open.

In these cases, we have to anticipate the possibility of changes in the surgical approach. Some monitors and procedures are much easier to do at the start of the case, but only become necessary if the patient is having open surgery rather than minimally invasive surgery. Anesthesia is very much a specialty of anticipation and we learn to plan for the worst and hope for the best.