Joan Rivers’ tragic death during what some have described as a routine outpatient procedure to treat her vocal cords highlights the risks that accompany any operation involving anesthesia and sedation.
In the wake of the 81-year-old comedienne’s death, two leading medical experts tell Newsmax Health the case underscores the need to ask several critical questions before undergoing any surgical procedure or operation involving sedation.
Anesthesiologist Kiran Patel and gastroenterologist Ian J. Lustbader, M.D., of the NYU Langone Medical Center say knowing the answers to four key questions could mean the difference between life and death.
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“You really want to know … where is the anesthetic going to be delivered [and] is it in a certified facility?” notes Dr. Patel, in an interview on Newsmax TV’s Meet the Doctors program. “Are there board-certified anesthesiologists delivering the anesthetic? Are they supervising nurse anesthesiologists and if so how many anesthesiologists are on staff there, and how many nurse anesthetists on staff?”
She also suggests it’s also important to find out who will be handling the sedation, how well the facility is equipped to handle an emergency, and if possible talk with the anesthesiologist day prior to the procedure, particularly if you have had any reaction to sedation in the past.
“If you have had a difficult reaction or any type of reaction to anesthesia … that [information] needs to be given to not only the anesthesiologist, but also the gastroenterologist who may be performing your procedure because that’s a significant concern. That may even change the gastroenterologist’s decision to do the procedure in an outpatient procedure or do the procedure in a hospital setting.”
Both doctors say it’s important to ask the following four questions before undergoing any procedure:
- Will a certified, registered anesthesiologist or nurse anesthetist administer the sedation?
- Is the clinic or healthcare facility there the operation is being performed equipped with emergency devices, such as a crash cart, EKG machine, and cardiac defibrillator?
- Does the facility or clinic have an agreement with a nearby hospital for urgent transfer should complications occur, and how will the doctors respond should something go wrong?
- What is the track record of the clinic and/or the doctors and specialists who will be performing the procedure?
Dr. Lust adds that such questions are particularly important when procedures are performed outside a hospital setting, such as in an outpatient clinic.
“Typically the ambulatory surgery centers or the outpatient endoscopy facilities … are inspected, they have to be certified, often they’re affiliated with hospitals, and often it’s a more pleasant experience for the patient so by and large these are accredited facilities, very safe,” he notes.
“But with any procedure you always want to ask: Why do I need the procedure? Are they any alternatives to the procedure? What are the risks to the procedure? How am I going to be sedated? What’s the experience of the anesthesiologist who’s going to be there?”
Although it is not known if sedation caused Rivers’ heart to stop, her cases has shone a spotlight on routine endoscopic throat procedures — during which a tube with instruments and a camera is typically inserted down the throat.
Usually some type of sedation is used for the patient’s comfort, either “moderate” sedation in which the patient is awake but relaxed, or “deep” sedation, using a drug. In either case, the medication is delivered intravenously.
Health experts say the potential risks of administering anesthesia should always be carefully assessed when an elderly person undergoes a medical procedure — even when it is considered minor.
The comic legend’s death should also motivate people to put their end-of-life instructions in writing before it is too late, experts say. Written end-of-life instructions make it much easier for family to cope when a loved one is dying. They are usually put into a document known as an advance medical directive. It can include:
A living will. This tells your doctor how you want to be treated if you are dying or unconscious and in what’s called “a persistent vegetative state” and cannot make decisions about emergency treatment.
Healthcare proxy. Sometimes known as a durable power of attorney for healthcare. This legal designation identifies a person, such as a family member, to whom you give the authority to make medical decisions for you when you are not able to do so.
A DNR or “do not resuscitate” order. This document tells the medical staff in a hospital or nursing facility that you do not want them to restart your heart should it stop beating.
It’s important to tell family members about your wishes and give copies of your advance directive to your doctor and to the person who has your medical power of attorney.
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