PIG Meeting: 11th March 2021
34 year old lady for hysteroscopy, endometrial biopsy and mirena
- Abnormal uterine bleeding for many years. No previous investigations.
- Super-morbidly obese. BMI 78
- Severe OSA. AHI 100 with >50% of sleep at saturations less than 85%
- Admission to ICU in last few years with respiratory failure post-URTI
- NIDDM. Good glycaemic control.
- Severe social anxiety.
- Declining spinal and/or light sedation. Requesting only GA.
- Booked as day-only procedure
- No HDU/ICU beds available. Other elective surgeries being cancelled.
- Oxygen saturations 86% on room air after moving onto theatre table.
- Extensive discussion with patient, surgeon, and anaesthetic colleagues about the risk of GA in day stay setting and no availability of HDU support.
- Decision made to postpone and rebook with ICU bed as patient very unhappy with anything other than GA
- At this point patient decides she will proceed with spinal.
- Opinion was that patient received a safe anaesthetic in the circumstances
- Ethics difficult as patient left with little choices on the day
- No local practice regarding day stay procedures in high BMI and OSA patients. See ANZCA professional document PS15 on Guidance for perioperative management of patients selected for day procedures.
- consensus was that it would be an unsafe day stay procedure if opioids administered.
- Many of these minor gynaecological procedures now being done under prilocaine spinal in the private with success (see attached BJA education paper on ambulatory spinal anaesthesia)