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P A T I E N T
M O N I T O R I N G
that can top $25 per procedure, says
patient (either artificially or manually)
Dr. Noback, which is a detractor. In
instead of continuing the anesthetic
his experience, based on a BIS trial he
while the dressings are being applied,
was part of (which was discontinued
to bring the exhaled anesthetic down
in the pilot phase), the readings can
to near zero. The patient will have
be discordant with the patient's state.
already begun the process of "blowing
Rather, he believes, the tools you
already have to judge presumed anesthetic depth are adequate. Monitoring
off" the anesthesia and will wake
faster.
The biggest changes in monitoring
the concentration of anesthetic in
standards have been the inclusions of
exhaled gases in particular can ensure
capnography and further details on
quicker wake-up in post-op. To do
temperature monitoring, says Dr.
this, says Dr. Noback, the provider
Noback, driven by changes in practice
should continue to ventilate the
at the front lines. "The inclusion of
LEGAL LIABILITY
When Vital Signs Are Ignored
I
ntraoperative monitoring is a staple of
his medical
surgery, so it's easy to forget just how
license
crucial blood pressure, EKG and pulse
suspended
oximetry really are. But a recent court case
for at least
provides a stark reminder of the dangers of
6 months, according to Florida Department
forgetting the vital importance of vitals.
of Health documents related to the discipli-
In 2008, a patient's blood or oxygen sup-
nary actions. And in June, he was found
ply was interrupted for several minutes, in
23% liable in the resulting medical malprac-
part due to the anesthesiologist's failure to
tice case (the surgeon took the rest of the
monitor pulse ox. The patient ended up
blame), which came with a $38.5 million
comatose and paralyzed. In December
award to the patient.
2012, the anesthesiologist was fined and
J U LY 2013 | S U P P L E M E N T
TO
O U T PAT I E N T S U R G E R Y M A G A Z I N E
— Stephanie Wasek
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