The clinical nurse anesthetist as diagnostic sleuth

Two cases are presented where observations made during anesthetic management led to appropriate diagnoses that otherwise might not have occurred in a timely fashion. In the first case, an early diagnosis of myasthenia gravis was facilitated; while in the second case, an improbable response led to rethinking of the initial diagnosis. The role of the nurse anesthetist in being alert to the consequences of unusual clinical and theoretical responses on behalf of the patient is depicted.