“To block or not to block, that is the question”: Anticoagulation and epidural anesthesia

The case An 85-year-old gentleman with hypertension, known diffuse coronary artery disease with two stents to his left anterior descending artery, and now a recent diagnosis of prostate cancer is scheduled to have a radical retropubic prostatectomy in your room tomorrow. His stents are drug eluting and were placed just under 1 year ago, and thus the patient continues to be on clopidogrel. The good news is that he comes with a preoperative cardiac evaluation. In this evaluation, the patient is deemed safe for surgery “only under neuraxial anesthesia due to his many known stenotic lesions that were not stented open.” Today, the patient presents with his family, angry because he is hungry and has been off clopidogrel for 5 days. Patient care Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families. In this case, as in every case, the first order of business when greeting the family is to establish rapport, instill confidence, and act in a manner to relieve patient and family anxiety. State your name, your title, and what you will be doing. Starting off on a good note can pay big dividends later, when you have to talk about whether the surgery will be done. Gather essential and accurate information about their patients.