Vital Times 2021 - 94

2022
It is 2022. The patient visits the anesthesia
department's preoperative clinic one week
prior to the date of surgery to discuss her
anesthetic management with a board-certified
anesthesiologist. The patient is offered several
different options for anesthesia, and the risks
and benefits of each are reviewed. She chooses a
regional anesthetic technique with a paravertebral
block for intraoperative and postoperative
analgesia, combined with an intravenous infusion
of propofol during surgery for sedation. She is
informed that propofol will reduce her risk of
nausea, and the nerve block will minimize her need
for morphine or other analgesics.
On the day of surgery, she is driven to an outpatient
ambulatory surgery center. Shortly after arrival,
she changes into a hospital gown. A physician
anesthesiologist visits her in the preoperative area
and introduces herself. After noting her NPO and
interval status, they review the anesthetic plan that
was discussed earlier in the preoperative clinic,
and they agree to use a combined regional/general
anesthetic technique.
An intravenous fluid infusion is started, and a
sedative is given through the IV. The patient is then
transferred to the operating room and placed on
the operating room table. Under local anesthesia, a
small catheter is placed into the paravertebral space.
Routine monitors are applied, including noninvasive
blood pressure, continuous ECG, pulse
oximetry, temperature, and once asleep, depth-ofanesthesia
and end-tidal carbon dioxide monitors.
The patient is preoxygenated with oxygen. The
paravertebral catheter is injected with a local
anesthetic, and the propofol infusion for general
anesthesia is initiated. A laryngeal mask airway is
inserted once the patient is asleep.
The site of the incision is prepped with
chlorohexidine, and sterile drapes are arranged
over the incision site. Everyone in the room
wear masks, and the surgeon and scrub nurse
wear sterile gloves. Antibiotics are given. During
surgery, additional IV analgesics and antiemetics
are administered in anticipation of postoperative
needs. The surgeon uses electrocautery, and blood
loss is minimal. There is no need to hurry the
operation. Antibiotics are given to prevent
surgical site infection. The case proceeds
uneventfully. After 75 minutes, the patient
emerges from anesthesia just as the surgical
dressings are applied.
When fully awake in the recovery room, the patient
denies any pain or nausea. Her vital signs are
stable, and blood loss was less than 100 mL. After
about one hour in the PACU, she is discharged
home with her husband.
94 | CSA Vital Times
Vital Times 2021

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