PIG Meeting: 11th February 2021

Case details

• Phone consult in preop clinic
  • History of well controlled, stable asthma
  • Noted to have sore throat – patient encouraged to obtain COVID test (negative)
  • Pt developed URTI, associated with asthma exacerbation. Surgery postponed.
  • Patient health check prior to new surgery date – symptoms resolved, ok to proceed.
  • DOS – patient acknowledges SOBOE (NYHA Class III). A marked decline from resp function pre-URTI. Wheeze in chest? Surgery cancelled by procedural anaesthetist.

Discussion

• Was this avoidable?
  • This patient was reviewed by phone in clinic, so while her chest was not examined, it seems that it was the URTI which developed after this consultation which led to her asthma deterioration.
  • Correct procedures were followed with a pre-op health check, however it was only with detailed questioning from the procedural anaesthetist that the patient revealed the key info.

• Would other anaesthetists have cancelled the patient? – Agreed that for elective surgery, with an ongoing respiratory exacerbation postponement is appropriate. Important to exclude other causes of new SOB (e.g. CCF) if expected resolution doesn’t occur.
• Have there been an increase in DOS cancellations with our move to phone consultations during COVID? – No
• Are we proceeding with surgery in patients whom we recognize are un-optimised to avoid DOS cancellations? – Not as per the meeting attendees.