|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 290
Timely decision-making: How it saved us!!!
Madhuri S Kurdi, Ashwini Halebid Ramaswamy
Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
|Date of Web Publication||6-May-2015|
Madhuri S Kurdi
Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kurdi MS, Ramaswamy AH. Timely decision-making: How it saved us!!!. Anesth Essays Res 2015;9:290
We anesthesiologists require an integration of both technical and nontechnical skills to work in a proactive, dynamic environment along with other team members.  Nontechnical skills such as situation awareness, applying predefined protocol, flexibility in decision-making and communication play a central role in good anesthetic practice.  We recently encountered two cases, which required an exemplary exhibition of these skills.
A 55-year-old hypertensive female with an uterovaginal prolapse on treatment was posted for elective vaginal hysterectomy. Her blood pressure (BP) recordings were between 170 and 180/90 and 100 mm of Hg preoperatively in the wards. She was referred to the physicians for optimization of her BP and put on oral Amlodipine 10 mg once daily. She had no signs of end organ damage. 3 days later, on the evening prior to surgery her BP recording was 160/80 mm Hg. She was given tablet Alprazolam 0.5 mg on the night before and on the morning of the surgery along with her usual anti-hypertensive medications. On the day of surgery, just before shifting her to the operating room, her BP recordings were in the range of 170 to 180/90 to 96 mm Hg. We decided to postpone the case. Back in the wards, 1 h after lunch, she complained of severe chest pain with sweating, went into a cardiac arrest and could not be resuscitated.
A 30-year-old female diabetic with hypertension and chronic calcific pancreatitis on insulin and tablet Olmesartan was posted for an elective lateral pancreaticojejunostomy. 12 days before the planned surgery, she was hospitalized. She had a good urine output. All her clinical investigations including blood urea, serum creatinine, serum electrolytes were within normal limits. On the morning of the planned surgery, surprisingly, her serum potassium level was abnormal (6.7 mEq/L) without any electrocardiogram signs. We decided to postpone the case. After thorough re-investigations, she was diagnosed with acute renal failure and underwent several sittings of dialysis.
In both these cases, we were faced with a clinical dilemma: To believe/not to believe? To give the case/cancel the case? After some thinking and some communication with the enthusiastic but sulking and disappointed surgeons, we decided to postpone the cases.
Anesthesiology fits into the complex dynamic world theory of Orasanu and Connolly, which has the criteria such as ill-structured problems, dynamic environment, environment full of uncertainties, intense time pressure and ill-defined goals.  The most crucial decisions usually have to be taken very fast and in a very short time.  The situations that we faced are an apt example of this. In a study, it was found that while majority anesthesiologists had good working relations with surgeons, over half of them did not believe that the surgeons understood the risks associated with anesthesia. Further, half of them had observed an anesthetist pressured into giving an anesthetic in an unsafe situation. 
Our cases clearly show that verbal communication, individual and team situation awareness, problem recognition and decision-making are important skills, which should be mastered by all anesthesiologists both trained and trainees.
| References|| |
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