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. 2001 Aug 11;323(7308):341.

Surgeons' attitudes to intraoperative death

Cardiac surgeons might have different attitudes

Norman Briffa 1
PMCID: PMC1120943  PMID: 11548680

Editor—Smith and Jones found out the attitudes of several surgeons to the edict from Sheriff Albert Sheenan in Scotland.1 I suspect, however, that if the same questionnaire had been sent to cardiac surgeons, the response might have been different.

There are essential differences in the significance of intraoperative deaths between cardiac and non-cardiac surgery. In cardiac operations the patients are being kept alive by the heart-lung machine while the surgeon operates on the heart, and it is only at the end of the procedure that an attempt is made to persuade the patient's heart to take over the circulation. After gastric surgery, the patient is not expected to eat a large meal immediately after. Similarly, after lower limb surgery the patient is not expected to jump off the operating table and run back to his bed. In cardiac surgery, however, it is essential that the heart resumes its work immediately at the end of the procedure. Intraoperative deaths occur usually when the heart is unable to do so successfully despite maximal pharmacological and sometimes mechanical support.

Intraoperative deaths therefore suggest that the operation has not been done in a technically perfect way, that the ischaemic period of the heart was too long, or that the heart was not protected adequately during the ischaemic period. All these are the responsibility of the surgeon and not the anaesthetist. It is therefore the surgeon on whom the burden of an intraoperative death tends to fall. Intraoperative deaths in cardiac surgery occur only after the surgeon has tried again and again to wean the patient off the heart-lung machine. This tends to take many hours. These operations are therefore both physically and psychologically draining, and most cardiac surgeons would probably find the advice of the sheriff both appropriate and comforting.

References

  • 1.Smith IC, Jones MW. Surgeon's attitudes in intraoperative death: questionnaire survey. BMJ. 2001;322:896–897. doi: 10.1136/bmj.322.7291.896. . (14 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2001 Aug 11;323(7308):341.

Anaesthetic departments need action plans to deal with such catastrophes

Boerge Christoph Seifert 1

Editor—Smith and Jones surveyed surgeons' attitudes to intraoperative death.1-1 This subject affects anaesthetists equally, if not more, as they are closely manage the patient's wellbeing during surgery. In this, as in a previous article, Jones does not take into consideration the effects that an unexpected intraoperative death has on other members of the medical and nursing staff, and the relatives concerned.1-2

Few articles address this subject in anaesthesia. Anaesthesia training centres focus almost exclusively on preventing potential disasters, whereas nothing really prepares anaesthetists in how to deal with them when they occur.1-3 Anaesthesia related deaths are extremely rare, but they do happen, often unexpectedly, leaving the individual anaesthetist feeling devastated. The emotional effects on anaesthetists are seldom discussed, and debriefing after a death is often haphazard. Guidelines on how to handle such a situation are available in only very few anaesthetic departments. We all assume that this will happen to somebody else, rather than ourselves, leaving the anaesthetist to whom it happens often feeling isolated and with little support.1-4 The nursing staff is likely to be equally affected, especially if children or young otherwise healthy adults are involved. There is a clear need to include the management of anaesthesia disasters into the curriculum of anaesthesia training.

Anaesthetic departments should have action plans on how to deal with catastrophes to reduce the suffering for all those involved. These should include guidelines on breaking the news to the family, the format of the interview, hospital paperwork, preparation for possible civil proceedings, and the debriefing of the theatre team.1-4 In an environment of clinical governance and an increasingly litigious society the question remains if the remainder of the operating list should be continued by a completely new team, including surgeon and nursing staff. On a background of suicide rates among anaesthetists, which are 10 times higher than those of the average population, it is important that we all support each other and help new generations of anaesthetists with guidance and open discussion.

References

  • 1-1.Smith IC, Jones MW. Surgeon's attitudes in intraoperative death: questionnaire survey. BMJ. 2001;322:896–897. doi: 10.1136/bmj.322.7291.896. . (14 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Jones M. Death on the operating table. BMJ. 2000;320:881. .(25 March) [PMC free article] [PubMed] [Google Scholar]
  • 1-3.Aitkenhead AR. Anaesthetic disasters: handling the aftermath. Anaesthesia. 1997;52:477–482. doi: 10.1111/j.1365-2044.1997.086-az0079.x. [DOI] [PubMed] [Google Scholar]
  • 1-4.Bacon AK. Death on the table. Anaesthesia. 1989;44:245–248. doi: 10.1111/j.1365-2044.1989.tb11235.x. [DOI] [PubMed] [Google Scholar]

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