Department of Anesthesiology
ANESTHESIA CLERKSHIP SELF-ASSESMENT AND STUDY QUESTIONS
Consider the following cases involving medical ethics in anesthesiology.
- A 55 year old Jehovah's witness presents for multi-level anterior and posterior spine fusion. During the course of your preoperative evaluation, you mention the possibility of blood or blood products transfusion. The patient states that he will not. under any circumstances, receive blood or blood products. Further, he states that he will aggressively pursue litigation against anyone who orders such transfusion. The patient does well until half way through the posterior portion of the procedure, when there is uncontrollable epidural vein oozing. Hemodynamics become unstable and measured Hgb is 7 gm/dl. Other lab tests reveal that the patient now has coagulopathy. What would you do? What should you have told the patient and patient's family pre-operatively?
- A 75 year old female with CRF. IDDM. and inoperable CAD presents with a hip fx. You plan to do a spinal. The family states "That's good because we don't want her to be intubated for any reason and another thing - no cpr or life support medicines."
What should you tell the family? If the spinal block gets too high and the patient needs short term intubation, should you intubate? What if the patient develops unstable ventricular tachycardia? What could this patient's primary care physician and surgeon have done to help prepare the patient and family for such a situation?
