Perioperative Medicine

Although most people think of an anesthesiologist as the gas-man during surgery, we often fill the role of the perioperative medicine physician to the surgeons before, during, and after surgery. Yesterday, I provided anesthesia for a patient with congenital prolonged QT syndrome and one with severe restrictive lung disease from scoliosis. Of course, these patients had been seen by their cardiologist and pulmonologist prior to surgery, who helped with optimization of medications and acquisition of appropriate tests. However, as the anesthesiologist for these patients, I was the one who had to interpret the data and recommendations. How do we plan an anesthetic that minimizes QT prolongation and reduces risk of arrhythmia? What rescue medications and monitoring is required? I realized that the surgeons didn't have a good grasp of the syndrome when they asked me if the patient could get any opiates. (In our electronic medical record, opiates trigger a warning because methadone prolongs QT and similar drugs alarm the system). For the patient with a precarious pulmonary status, I had to decide whether to extubate the patient, and even if extubated, whether an intensive care bed was more appropriate. I advised the surgeons with regard to medications to avoid, therapies to reduce atelectasis, and pain control techniques to reduce splinting. All this reminded me that even if patients see their specialists, anesthesiologists are often the doctors who remind surgeons how best to address the nonsurgical issues.