QUESTION: I have a patient with a MTHFR mutation who needs surgery. Can I legally sign off on anesthesia, and if so. . . is it safe with that mutation?

ANSWER: This is a great question, and as I have not much to do with my life I thought I’d answer. First the legality of it is fairly clear – if you essentially can function as a PCP you can do these. I have done them for many years and it is no big deal. That said if you don’t feel comfortable signing off on anesthesia then I’d get a mentor to help you on the first one. Next issue is some hospitals (regardless of the law) won’t take a pre auth from an ND. The medical standards and literature are really clear on what is required.

In a quote from the excellent review – Preoperative evaluation and preparation for anesthesia and surgery – much comfort and happiness can be had: The following primary goals of preoperative evaluation and preparation have been identified: Documentation of the condition(s) for which surgery is needed. Assessment of the patient’s overall health status. Uncovering of hidden conditions that could cause problems both during and after surgery. Perioperative risk determination. Optimization of the patient’s medical condition in order to reduce the patient’s surgical and anesthetic perioperative morbidity or mortality. Development of an appropriate perioperative care plan. Education of the patient about surgery, anesthesia, intraoperative care and postoperative pain treatments in the hope of reducing anxiety and facilitating recovery. Reduction of costs, shortening of hospital stay, reduction of cancellations and increase of patient satisfaction.

In the case, as you describe it, if you can meet these criteria you are fine. With one MTHFR mutation (if that is all) there is little issue. I would suggest good nutrient support pre and post to boost antioxidants, and tissue healing (which you should do with all patients).

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