So, Who's Responsible for Clearing Patients for Anesthesia?
Re: "A Case of Inadequate Informed Consent" (April, page 25). It should have been clear to the anesthesiologist that this patient with significant cardiac and pulmonary morbidity and an undefined degree of obesity wasn't a candidate for interscalene block. Not only did the block have to be converted to general anesthesia, but it also complicated the course of general anesthesia, as this patient would certainly need post-operative ventilator support because of the successful interscalene block. The shortness of breath and restlessness is a symptom of phrenic nerve paralysis, which is typical in a successful interscalene block. Of course, this patient needed rescue as he had longstanding COPD, coronary artery disease and heart failure with cardiomyopathy. The anesthesiologist should not have been left off the hook on this one. Poor choice!

Michael Wolf, CRNA
Renaissance Surgery Center
Oshkosh, Wis.
michael.wolf@chnwi.org