Anesthesia Alert: Patient Care in an Impatient World

Mr. Smith has been sitting in his hospital gown on a cold stretcher waiting to be brought back for surgery. The 62-year-old glances at the clock on the wall, which reminds him that he has been waiting alone, thanks to the pandemic restrictions, for 45 minutes. He looks down at his arm and sees gauze pads and tape, reminders of when the new nurse tried, unsuccessfully, to place his IV before a more experienced provider was able to do it. He hears the distant murmurs of providers beyond the curtain and wonders what’s going on. A nurse comes to check on him, but he grumbly mumbles and crosses his arms while registering only the words “delay.”

On the other side of the curtain, the understaffed and overworked preoperative team is hurriedly checking in patients, assembling their charts, placing IV lines and starting antibiotics. Two hours past his scheduled start time, a member of the surgical team finally comes to take him back to the operating room. They talk over him, stopping only to ask him his name and birthday as part of their safety check. Mr. Smith refuses to answer. He is hungry, angry and tired. He raises his arm and clenches his fists as the nurse asks to check his ID bracelet.

It helps if providers can determine the source of the problem and how it relates to their current state. Have patients been waiting a long time without any updates or communication from members of the care team? Are they in pain or uncomfortable? Are they hungry or thirsty? Providers must keep the lines of communication open and update the patient if there is going to be a delay. If the delay is expected to be greater than two hours, they should determine if the patient can have a sip of clear liquids. If the patient is in discomfort, they should consider administering pain medication.

Manipulative patients tend to use threats of legal action or guilt in impulsive attempts to get what they desire. When interacting with these types of patients, it’s important for providers to set limits, understand the patient’s expectations and be aware of their own reactions. Manipulative patients are often used to being in charge at work or at home. They might be the primary caregiver in a relationship or family, and are often burdened with a lot of responsibilities. Ultimately, a loss of control over their current situation can feed into their behavior. Maybe they feel that waiting is a waste of their valuable time. Perhaps they were recently given a life altering diagnosis, such as cancer, and are still at odds with the diagnosis and treatment.

The interactions anesthesia providers have with patients are often limited to the preoperative assessment period, where they get the chance to ask patients pertinent questions regarding their health history in order to formulate a safe anesthetic plan. They often deal with anxious patients who are nervous about going under anesthesia.

There are many reasons the thought of anesthesia can cause anxiety in patients. Anesthesia providers should review the chart and ask the patient targeted questions to determine the potential underlying cause of their uneasiness. Is it their first time undergoing anesthesia? Did something bad happen to the patient the last time they had a procedure? Did a loved one have something happen to them when they underwent surgery? Are they afraid of waking up in the middle of the procedure? Do they have an underlying anxiety disorder for which they take medication? If so, when was the last time they took the medicine?

If patients are afraid of waking up in the middle of a procedure, take the time to explain the type of anesthesia that will be used for the case and why they’ll remain properly sedated throughout the surgery. If soothing words aren’t effective in calming a patient’s nerves, administering midazolam before surgery helps to reduce their anxiety.