Expert: Dr Ian Jackson - please note UK based - 2/4/2010

Question
Hi Dr Jackson,

You helped me so brilliantly before, hopefully you can point me in the right direction this time.  I understand that patients that have undergone procedures under Anaesthesia are to be monitored post procedure for either complications or side effects ie: Respiratory Arrest.  

My question is this, are there different post procedure monitoring guidelines for those that are terminally ill?  So in other words, is oxygen therapy and monitoring of the patient still the same regardless of terminal illness or in a healthy patient?  

The reason for asking is that I have been told that because one maybe a palliative care patient that there are different standards for these patients - I thought that monitoring, oxygen were well within the realm of post operative care regardless of condition.  I do not refer to DNR orders.  

Can you please point me towards guidelines that are specific to the monitoring post procedure of terminally ill patients?  I find it hard to believe that there would be different standards of perioperative monitoring just because someone has cancer?  (aside from DNR).  NHS guidelines are fine.
Thank you
P

Answer
Hi there
I do not believe anyone would produce specific guidelines for this group of patients.
We would never differentiate against this group - monitoring and management would be the same as per normal patients. Having taken the serious decision that they need an operation (despite being terminally ill) then we would do everything to make sure they didn't succumb whilst under our care. If death was the inevitable outcome of the attempt then I would be very unlikley to anaesthetise them.
I would manage as normally and give oxygen therapy where it is indicated based on oxygen saturation, preoperative therapy and procedure performed. (I do not advocate the automatic administration of oxygen in PACU but rather the the targeted use of this where indicated)
That deals with those with a terminal illness eg cancer presenting with bone fracture secondary to metastatic spread. The other group you may be discussing are the patients who are in extremis have a last ditch attempt at surgery but are found to be inoperable. These patients are often made comfortable and relatives given time to see them and any monitoring and therapy aimed purely at ensuring comfort.
I hope this helps but feel to ask further.
Kind regards
Dr Ian Jackson