Expert: JM Starkman, MD - 11/25/2009

Question
My mom underwent chemo which ended about 5 months ago. During her second session she had some complications and it turned out that the chemo had caused some kind of heart muscle weakness or otherwise compromised her heart. Well the cardiologist did a stress test and EKG and they changed the chemo to another "formula" and they said she was fine, no serious damage and she was cleared for her last few chemo sessions. She also had some blood pressure issues for which she is taking medication.

Now she needs to go into surgery because the PET scan revealed a few spots in her pelvis that look suspicious. They call it exploratory surgery. They did EKG and everything but right before the surgery, the anesthesiologist was apprehensive about putting her under general anesthesia saying that because of her heart condition documented after the last chemo, he cannot put her under  anesthesia until the cardiologist clears her for surgery (i.e does a stress test etc).

My question is, given all this history, how safe is surgery? Do they just change the formula for the kind of anesthetic agent they use? What would they do different to account for her heart problems? Her EKG was reading fine in the pre operation tests and right before surgery. Is it safe? I mean people with actual heart surgeries go under anesthesia. How big are the risks still if her cardiologists clears her for surgery? Would there be a circumstance in which he wouldnt clear her? (but she needs this operation to remove the suspicious spots). I am worried sick and it is unclear to me what the risks are.  

Answer
You are asking all the right questions and doing a better job of it than most cardiologists who are brought into this issue!  All a cardiologist can do to help an anesthesiologist prior to a surgery/anesthetic is evaluate the patient.....PERIOD.  "Risk assessment" really means very little unless the anesthesiologist who has the data HE needs (not necessarily what the cardiologist provides) feels the anesthesia is too dangerous to proceed.  But that is hardly ever the case, because as you note, "people with actual heart surgeries go under anesthesia".  Any decent anesthesiologist can safely anesthetize a patient with a poor heart.

Unless your Mom is a cardiac cripple, the answer to your question is: the anesthesia is safe.

I really think you and your family are a victim, here, of the nagging medical-legal problem that exists in our country today.  All involved feel that if anything goes wrong, a lawsuit is inevitable......so they're spreading the "blame" around but good.  Without strong legal backrounds, though, this is not accomplishing much to protect them legally, but just bringing more deep pockets into the mix.  

Talk to the anesthesiologist who will do her anesthesia. Ask him what studies he needs to safely proceed at this point (I would think none in addition to what's already been done).  Offer him a waiver of liability if that will help him get going on this.