Page 49 - 2022 Risk Basics - Anesthesiology

SVMIC Risk Basics: Anesthesiology

there is a pre-procedure indication that difficulties may be

encountered.

CASE STUDY

A 44-year-old female with a history of hypertension, being
a two pack-per-day smoker, and mild obesity was
diagnosed with an abdominal mass. The initial exploratory

laparotomy was cancelled due to an abnormal EKG. The
patient underwent a cardiac workup which revealed left

ventricular hypertrophy (LVH) and mild aortic
regurgitation. After the workup was complete, she was

rescheduled for surgery.

The anesthesiologist did not evaluate the patient prior to
surgery and was not present for the induction. A pre-op

evaluation was performed by the CRNA with ASA 3

assigned. The airway was judged to be within normal limits
on this evaluation and prior anesthetic history was

negative for any problems.

The patient was taken to the OR, monitors were placed,
and the CRNA began induction with Diprivan,

Succinylcholine, Versed, and Fentanyl. The

anesthesiologist was not in the OR at the time of induction.
The patient was intubated with a Miller 3 blade with a #7

endotracheal tube but could not be ventilated. The tube
was removed and reinserted, but the CRNA still could not

ventilate the patient. The tube was removed and bag valve
mask ventilation was attempted with minimal success. The

patient’s oxygen saturation fell to 88 percent. The

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