As we all know anesthesia comes in varying degrees. It can be conscious sedation, to monitored anesthesia care where the patient gets very little sedation to deep sedation. It can also be general anesthesia or combination of all of those mentioned with a regional technique.
Regardless of the type of anesthesia what we need to remember is this….anesthesia affects everyone differently. The onset of Propofol has made the outpatient anesthesia experience very pleasant for patients. If used as the sole source of anesthesia the patients wake quickly with little to no side-effects and are alert and oriented when they leave.However, when sedation is given by using a combination of benzodiazepines and narcotics; with or without Propofol, patients may respond differently post-procedure.
Before patients can leave a facility they must meet the discharge criteria determined by that facility. Their vitals are stable, they can drink, go to the bathroom and ambulate without problems. They may feel a little groggy but they know what is going on and appear “normal.” The problem is there is really know way of knowing how the patient really feels. They will tell the nurses they feel fine and they probably do but ask them an hour later and they will not remember talking to the nurses.
The medications given in a combination anesthesia will cause amnesia and a lack of inhibition, like an intoxicated type state. The degrees of the state of inhibition may vary but this behavior is something that we as anesthesia clinicians need to be more conscious of. We tell people that they should not drive following sedation or general anesthesia; we tell them they should not make important, life changing decisions. But, do we tell them they should not get on the internet?
In a recent article I found the following incident that occurred:
“Recently, a patient’s husband was upset when his wife returned for a diagnostic test. On further discussion, it was revealed that his concern wasn’t the quality of care, the size of the bill, the amount of the deductible, or the length of the wait, but the fact that his wife had spent a large amount on the Home Shopping Network (“HSN”) during the afternoon following her last procedures and sedation.”
After reading this I realized that we owe it to our patients to ensure that they truly understand the affects that anesthesia may have on them and advise them accordingly. In our high tech world we should stop and consider that people may get on line and shop
or even text people and say things they may not normally say. This could cause devastating consequences that ultimately we as clinicians could be responsible for.