Ensuring Comfort and Safety: Anesthesiologists’ Vital Role in Complex Cases
Having a baby is one of life’s most memorable experiences, and the planning efforts of the multidisciplinary care team are vital to making it a joyful one for each family.
“The entire care team must be prepared for both the likely and unlikely scenarios to ensure that it’s a positive experience,” said Jean Marie Carabuena, MD, director of High-Risk Obstetric Anesthesia.
That is especially true for patients with complex conditions who are planning to deliver a baby. BWH cares for obstetrical patients with heart conditions who are part of the Boston Adult Congenital Heart (BACH) Service, a joint program of BWH and Boston Children’s Hospital. Many years ago, children born with congenital heart disease didn’t survive into adulthood, but as treatment options improve, they are not only surviving, but having families of their own, too.
BWH Bulletin recently featured a story about 29-year-old Chelsea Phaneuf, who remained in the hospital for weeks receiving care and monitoring while she waited to give birth and undergo heart valve replacement surgery. Thanks to every member of her care team, Phaneuf and her baby girl, Aria, are home and doing well.
In a case like Phaneuf’s, planning for multiple scenarios weeks in advance of the delivery and surgery is critical, as is coordinating the input of multiple services who may need to be involved in the care of mother and baby.
“For patients with complex conditions, communication and planning are essential. Coordination of care is necessary in anesthesiologists’ role as crisis managers,” said Carabuena, who coordinated the team’s obstetrical anesthesiology care for Phaneuf.
Anesthesiologists are uniquely qualified to assist in this key role. In addition to delivering medications that keep patients comfortable during surgical or obstetrical procedures, anesthesiologists ensure a patient’s normal physiology is maintained. They are specially trained to place advanced monitors that quickly identify if something is wrong and then treat the patient accordingly.
“From our perspective in anesthesiology, we naturally assume this integrative role on a daily basis when it comes to coordinating and executing the care of complex patients,” said Jennifer McSweeney, MD, who has been a member of the Cardiac Anesthesiology Service for five years and coordinated care for Phaneuf on behalf of this team. “Our cardiac team has expertise in looking at the finer details in developing cohesive and comprehensive plans for high-risk cases and planning for contingencies.”
Obstetrical patients with congenital heart disease present several challenges during the physiological changes that occur during labor and delivery. Anesthesiologists are part of the care team discussions in determining which cardiac monitoring is necessary, providing a plan for pain relief during delivery and after, and making contingency plans, should cardiac surgery be needed. In that case, perfusionists would play a major role in putting the patient on cardiac bypass.
“As cases get more complex, it’s a challenge to figure out how to integrate all of everyone’s collective individual knowledge and experience across these subspecialties and align strategies as a team towards a common goal,” said McSweeney. “It takes teamwork, good communication and mutual respect to provide the highest quality of care for our patients.”
John Fox, MD, senior member of Cardiac Anesthesiology, praised both McSweeney and Carabuena. “They are excellent clinicians and compassionate physicians, but above all, they are consummate team leaders and team members who keep the patient’s well being at the fore of team discussions,” he said.
For Carabuena, every obstetrical patient is special, and to be instrumental in ensuring their safe and comfortable delivery is gratifying. “Patients may not always remember their anesthesiologists’ names, but they do remember our faces and voices,” she said.
She and McSweeney both say they will certainly remember Phaneuf and her family.
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