EP189: Interview with Dr Zalstein Talking Anesthesia (Part 2)

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop, a practicing cardiologist and patient education advocate, hosts this episode with Dr. Sandy Zalstein, an anaesthetist colleague, in their second interview together. The discussion focuses on practical challenges anaesthetists face when preparing patients for surgery, particularly those with complex medical conditions, and emphasizes the importance of patient optimization and risk assessment before elective procedures. Key Takeaways: Anaesthetists assess patients using a four-part framework: evaluating risk, optimizing health status, planning appropriate care, and anticipating potential complications or pitfalls. Patient optimization varies significantly based on urgency: elective procedures allow time for comprehensive optimization to achieve the lowest perioperative risk, while emergency cases require rapid "resuscitation" optimization on-site. Elective surgery patients should be "beautifully optimized" with identified health issues assessed and addressed by appropriate specialists before proceeding to surgery. Anaesthetists may delay or cancel elective surgery if patients aren't adequately optimized—for example, a patient with severe heart valve disease and reduced cardiac function was appropriately declined surgery until proper cardiac optimization occurred. Clear communication about surgical risks and benefits is essential for patient preparation and family understanding, as modern medicine no longer operates in a "zero-risk" world. Surgeons and anaesthetists should work collaboratively to educate patients, with surgeons explaining procedural risks and benefits, and anaesthetists then discussing anaesthesia-specific considerations and outcomes. Intermediate-urgency cases require anaesthetists to work with other clinicians to address acute issues quickly while still optimizing the patient within available timeframes. Patient education and engagement in the consent process directly impacts emotional preparedness and outcomes if complications occur.