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Master Thesis

Le processus décisionnel en situation d’urgence chirurgicale digestive au sein du binôme médecin anesthésiste-réanimateur / chirurgien

Abstract : Making the decision to perform major emergency digestive surgery in some patients, particularly elderly and comorbid, can be difficult for anesthesiologists and digestive surgeons. No studies have examined the experience and decision-making process of the anesthesiologists / digestive surgeon pair in these situations.
We conducted a qualitative research among anesthesiologists and digestive surgeons performing emergency digestive surgery. A clinical case was proposed followed by a semi-structured interview.
In March 2020, 4 digestive surgeons and 4 anesthesiologists practicing in university hospitals were included. They all perceived the decision to disqualify surgery in a life-threatening emergency context equivalent to a decision of withholding or withdrawing life sustaining therapies. There was no consensus on the criteria for deciding between patients: only those already under palliative care or severely bedridden or demented were easily disqualified. It was an anxiety-provoking decision for the doctors, who favored anticipation or transfer to a multidisciplinary team, after having carried out surgery followed by a standby resuscitation. The sharing of the decision was defended in the sense of a common construction. The anesthesiologist was recognized as a specialist in general condition; whereas digestive surgeons oscillated between a purely technical opinion and a legitimacy to assess the overall condition of the patient. The intensivist helped to form a medical and surgical team, participating in decision-making when no other external professional was available. Conflicts were frequent, but attributed to organizational difficulties rather than to the decision to operate per se. The patient's geographical location within the hospital structure determined who was to inform him, leaving the anesthesiologist in a supporting role to the surgeon or the intensivist.
Anesthesiologists and digestive surgeons are in agreement with the few existing recommendations regarding peri-operative limitations of life sustaining therapies. The reality of the apparent consensus in the discourse could be questioned by a larger survey with an anthropological observation side.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03231185
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Submitted on : Monday, September 6, 2021 - 3:39:13 PM
Last modification on : Wednesday, September 8, 2021 - 3:11:10 AM

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  • HAL Id : dumas-03231185, version 1

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Margot Arminot-Frémaux. Le processus décisionnel en situation d’urgence chirurgicale digestive au sein du binôme médecin anesthésiste-réanimateur / chirurgien. Ethique. 2020. ⟨dumas-03231185⟩

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