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Silence is Golden? Anesthetic Hits and Misses While Caring for a Laboring Patient using American Sign Language Video Interpretation
Abstract Number: T5C-3
Abstract Type: Case Report/Case Series
Hearing loss is the 6th most common chronic condition in the United States. Unique challenges are presented to the anesthesiologist when caring for this patient population. Unfamiliarity with socio-cultural and linguistic aspects of the Deaf community may foster distrust with the health care provider. Imperfect knowledge of pre- or post-lingual deafness designation and preferred corresponding method of communication, such as American Sign Language (ASL), may lead to poor patient satisfaction and outcomes (1). Unfortunately, there is little evidence-based guidance or training for anesthesiologists on how to best provide care for this population, which may lead to disparities in health services provided. We describe one such case of multiple failed labor neuraxial in an ASL patient.
23 yo G1P0 @ 39+3 with congenital deafness and obesity BMI 38 was admitted to Labor & Delivery for IOL secondary to NIDDM. Using a video interpreter for ASL, a history, physical, and discussion of the anesthetic plan were conducted. At the time of labor neuraxial placement, simultaneous real time ASL video interpreter and a diagram on the patient’s lap were used to facilitate placement. The diagram consisted of the letters “L”, “M”, and “R” which corresponded to “Left”, “Middle”, and “Right”. By pointing to the corresponding letter, the patient was able to provide real-time feedback to the resident placing the epidural in order to identify the patient’s midline. A CSE was attempted, but absence of CSF in the spinal needle and long placement time led the anesthesiologist to thread the catheter after reconfirming LOR. A positive test dose for IV placement was suspected, and the catheter was removed. A second attempt of labor neuraxial placement was made by the same anesthesia team using the same methods. Lack of CSF return during CSE placement resulted in subsequent catheter failure. Maintaining continuity of care, a third attempt at a labor epidural was discussed as the patient was still in pain and remote from delivery. During this discussion, the patient expressed physical and visual fatigue due to focusing on the ASL video interpreter during the lengthy discussion. Careful, detailed, and empathetic conversation allowed for a successful third attempt at labor epidural using pre-procedural lumbar ultrasound.
Providing care for the hearing impaired can present certain challenges for anesthesiologists. This case illustrates how communication barriers may contribute to delays in recognition of failed neuraxials or other anesthetic procedures required in the L&D department, but also highlights how committing to an effective communication process can have a significant and beneficial impact on patient satisfaction and outcomes.
1. O’Hearn, A. Family Medicine. 2006 Nov-Dec; 38 (10): 712-6.