Varkoly Kyle S, Beladi Roxana, Ritrosky Steven
Cardiology, Kansas City University of Medicine and Biosciences, Joplin, USA.
General Surgery, Kansas City University of Medicine and Biosciences, Joplin, USA.
Cureus. 2020 Oct 9;12(10):e10865. doi: 10.7759/cureus.10865.
Most preoperatively discovered complete heart block cases without cardiac clearance in a non-emergent situation are managed with deferral of elective surgery until a cardiology workup can be completed. The medical consequences of surgical delays can manifest in increased costs to the healthcare system via the treatment of more advanced disease, often requiring more intense and more costly treatment in addition to the emotional burden of delay on a patient that has been waiting months for a particular surgery. Delays in surgery have real impacts on patient health outcomes, hospital finances, and patient satisfaction. We present a rare case in which a proactive anesthesiologist was able to take measures to stratify patient safety risk and safely prevent the delay of the surgery in an asymptomatic and unfollowed congenital third-degree heart block patient. The anesthesiologist demonstrates the use of established guidelines for non-elective noncardiac surgery to safely and effectively prevent the delay of an elective inguinal hernia repair in the setting of a situation that normally warrants its delay. Using these pre- and intraoperative measures, the anesthesiologist was able to prevent the delay of elective surgery, and this should set a precedent of the necessary steps involved to safely manage a patient with an unfollowed third-degree congenital heart block.
大多数术前发现的非紧急情况下无心脏许可的完全性心脏传导阻滞病例，会推迟择期手术，直到完成心脏病学检查。手术延迟的医疗后果表现为，通过治疗更晚期疾病，医疗系统成本增加，这通常除了给等待特定手术数月的患者带来延迟的情感负担外，还需要更强化、更昂贵的治疗。手术延迟对患者健康结局、医院财务和患者满意度都有实际影响。我们呈现一个罕见病例，一名积极主动的麻醉医生能够采取措施对患者安全风险进行分层，并在一名无症状且未接受随访的先天性三度心脏传导阻滞患者中安全地避免手术延迟。该麻醉医生展示了如何使用既定的非心脏非择期手术指南，在通常需要延迟手术的情况下，安全有效地避免择期腹股沟疝修补术的延迟。通过这些术前和术中措施，麻醉医生能够避免择期手术的延迟，这应为安全管理未接受随访的三度先天性心脏传导阻滞患者所需的必要步骤树立一个先例。
