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Surgeon Makes Tutorial DVD For Conscious Open-Heart Surgery

Posted by samzenpus on from the looks-easy-enough dept.

Lanxon writes "Swaroup Anand, 23, from Bangalore, was fully conscious as he underwent open-heart surgery. An epidural to the neck, administered at the city’s Wockhardt Hospital, numbed his body during the procedure. Dr Vivek Jawali pioneered the technique ten years ago and has recently released a tutorial on DVD, which gives a step-by-step guide to the procedure for other surgeons to watch and learn from."

4 of 170 comments (clear)

  1. Re:Would you like to be awake for this procedure? by MightyMartian · · Score: 4, Informative

    It's likely because there are greater risks involved in general anesthetic. Where possible, it's seen as safer for the patient to use only locals.

    --
    The world's burning. Moped Jesus spotted on I50. Details at 11.
  2. You aren't exactly wide awake... by sirwired · · Score: 4, Informative

    There are many different surgeries done now where the patient is not rendered unconscious. Advances in technique and in local anesthetics have made the precision nerve blocks required possible. However, make no mistake, you aren't wide awake and cracking jokes while the surgeon does his thing; you are doped to the gills with tranquilizers. It would be very bad if you panicked or tried to move around during the surgery. Keeping you awake is done because it is easier to keep you from not dying when they aren't trying to put you to sleep, shut down sensation of pain, and cut your memory. They don't do it because it's really cool, or to educate the patient.

    SirWired

    1. Re:You aren't exactly wide awake... by demonlapin · · Score: 5, Informative
      This is not exactly true. There are a lot of medications used in anesthesia, but the short list includes:
      • General anesthetics. Come in IV (propofol, thiopental) and gas (there are more modern ones, but ether and chloroform are the ones people know) forms. Produce global depression of nerve function so that unconsciousness results.
      • Opioids. Morphine, fentanyl, etc. Produce relief of pain without necessarily depressing consciousness. Dangerous in overdoses because they depress the respiratory drive - people quit breathing and die. This is not usually a problem during general anesthesia because there's a tube in your throat that's hooked up to a ventilator - we breathe for you.
      • Paralytics. Particularly important at two points: at the beginning, they make putting that tube down easier (you don't fight), and during abdominal or orthopedic surgery, they relax the muscles so that the surgeon can work.
      • Anxiolytics. These are IV versions of Valium or Xanax, used to calm people down and make them forget what's happening.

      Now, there is a problem with postoperative cognitive dysfunction in the elderly, one that is currently a very hot topic of research, but the elderly don't have a lot of plastic surgery - if they're in for surgery, they usually need it to continue living.

      Finally, very few people die - the risk is somewhere less than 1 in 150k for elective surgery, with risks rising for those who are having risky surgeries or who are very ill to start with. Anesthesiologists made a conscious decision in the early 1980s to reduce the risks of anesthesia, and created the Anesthesia Patient Safety Foundation to review all closed claims - that's lawsuits, settled in or out of court - and to look for common factors. We have been enormously successful at this task. Drugs have been pulled off the market because the APSF identified them in series of deaths. Safety equipment has been mandated - for example, the size of the connectors for breathing masks, breathing tubes, and ventilators is specified so that all of it interoperates, regardless of manufacturer.

      If you prefer to be unconscious for surgery, it can usually be done safely. Of course, if you want to be awake, that can usually be done safely as well. Ask your anesthesiologist.

  3. Re:Would you like to be awake for this procedure? by demonlapin · · Score: 4, Informative

    I think if you put it in at, say, T6, and really, really carefully dosed your local, you could make it work - produce your block from C8 to T10/12. But I share your concerns about staying extrapleural, and even then the loss of intercostals, etc., would kill their tidal volumes. And the guy in the article summary is really young - maybe a straightforward valve in an otherwise ASA I? I emailed the Wired UK editors, asking for a contact point at the hospital so I can see this for myself. Maybe I can take it to our CT surgeons when I'm done... :)