TITLE:
Supracervical Lymph Node Biopsy under Local Anesthesia: A Cautionary Tale!
AUTHORS:
Steven D. Boggs, Elizabeth A. M. Frost
KEYWORDS:
Patient Safety, Preanesthetic Assessment, Patient Scheduling
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.5 No.3,
March
25,
2015
ABSTRACT: A middle aged woman was scheduled for supracervical lymph node biopsy under local anesthesia. A scheduling conflict caused a significant operating room delay and she became very nervous. A surgical resident asked for anesthetic assistance in calming the patient. Assured that the case was under local anesthesia only, the anesthesiologist gave the patient soda to drink. In the operating room, the lady could not tolerate the procedure but as she now was at risk for aspiration, the anesthesiologist suggested the case be terminated and rescheduled. The surgeon disagreed and continued but was confronted with substantial bleeding. Emergency induction of general anesthesia was required. Postoperatively bleeding continued requiring re-exploration and intensive care unit admission. The patient developed a compressive left brachial plexopathy. The anatomy of the area indicated that general anesthesia was the preferred technique. The importance of team work and communication is underscored. Complications are more frequent when perioperative changes are made.