Supracervical Lymph Node Biopsy under Local Anesthesia: A Cautionary Tale!

Steven D. Boggs¹, Elizabeth A. M. Frost²

¹James J. Peters Veterans Administration Hospital, New York, USA.
²Icahn Medical Center at Mount Sinai, New York, USA.

DOI: 10.4236/ojanes.2015.53009                

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.

Keywords

Patient Safety, Preanesthetic Assessment, Patient Scheduling

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	O’Rahilly, M., Carpenter and Swenson (2015) Basic Human Anatomy: A Regional Study of Human Structure. http://www.dartmouth.edu/~humananatomy/part_8/chapter_50.html
[2]	Sinnatamby, C.S. (2011) Last’s Anatomy. Elsevier, Amsterdam, 329-454.
[3]	Lin, D.T. and Deschler, D.G. (2012) Neck Masses. In: Lalwani, A.K., Ed., Current Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, The McGraw-Hill Companies, New York.
[4]	Mandpe, A.H. (2012) Neck Neoplasms & Neck Dissection. In: Lalwani, A.K., Ed., Current Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, The McGraw-Hill Companies, New York.
[5]	http://teachmeanatomy.info/neck/areas/anterior-triangle/
[6]	http://teachmeanatomy.info/neck/areas/posterior-triangle/
[7]	Skinner, D.B. (1963) Scalene-Lymph-Node Biopsy. New England Journal of Medicine, 268, 1324-1329. http://dx.doi.org/10.1056/NEJM196306132682402
[8]	Ferencsik, M., Plukovics, K., Borbenyi, Z., et al. (1990) Peripheral Nerve Injuries as a Rare Complication of Cervical Lymph Node Excision for Diagnostic Purposes. Orvosi Hetilap, 131, 1465-1467.
[9]	Domino, K. (2014) American Society of Anesthesiologists Closed Claims File. Personal Communication.
[10]	Dutton, R. (2014) Anesthesia Quality Institute. Personal Communication.
[11]	Villa, H. (2014) American Association for the Accreditation of Ambulatory Surgery Facilities. Personal Communication.
[12]	ASA (2011) Standards for Basic Anesthetic Monitoring. http://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/standards -for-basic-anesthetic-monitoring.pdf
[13]	CMS Hospital CoP (2013) Anesthesia Guidelines. http://www.ahcmedia.com/images/T13143_ColorHandouts.pdf
[14]	San Millan Ruiz, D.G.P., Rufenacht, D.A., Delavelle, J., et al. (2002) The Craniocervical Venous System in Relation to Cerebral Venous Drainage. American Journal of Neuroradiology, 23, 1500-1508.