A surgeon did an operation under local anesthesia with sedation in a very anxious, elderly patient. Everyone was aware of the patient’s anxiety, and she was maintained on midazolam (Versed) by an anesthesiologist throughout the procedure, which went smoothly.

When she returned a few weeks later for a similar procedure at another site, a different anesthesiologist was involved and refused to sedate the patient, who complained bitterly after the case.

She said if she had known that sedation was not going to be given for the second procedure, she would not have undergone it. She filed a formal complaint with hospital administration as did the surgeon.

The preoperative nurse told the surgeon that she had spoken with the second anesthesiologist and informed him that the patient was anxious and wanted a similar type of sedation for the second case, but he refused to give it.

He accused the nurse of telling him how to do his job.

For now, the anesthesiologist in question is no longer being assigned to the surgeon’s cases.

What happens when anesthesia and surgery disagree?

There is no simple answer to this issue.

Anesthesia is one of the few specialties that you must consult and work with but have no control over who is assigned to your cases. You may have a couple of “go to” internists or cardiologists. You can ask your favorite radiologist to look at an x-ray for you. But anesthesiologists are assigned to you by the chief of anesthesia or the anesthesiologist-in-charge for the day. So no matter how incompetent or disagreeable a particular anesthesiologist is, you may have to work with her whether you like it or not. This also is true of emergencies on nights and weekends.

To be fair, I suppose they feel the same way about certain surgeons too.

The situation will not likely be resolved to everyone’s satisfaction although the administration might pay a little more attention since the patient complained too.

The surgeon’s reward for complaining will probably be a large helping of passive-aggressive behavior from that anesthesiologist the next time they do a case together.

This reminded me of what happens when you get an anesthesia consult ahead of time for a patient you know is going to be complicated. The anesthesiologist who does the consult may say, “The patient doesn’t need a cardiac stress test.” But on the day of surgery, it’s is ALWAYS a different anesthesiologist who, of course, will not put the patient to sleep without a stress test.

Don’t get me started on stress tests, which a recent study found were inappropriate in many instances possibly wasting half a billion dollars.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,500 followers on Twitter.