Science Ain't So Bad

"Is it my imagination or is this one kinda restless?"

OW! OW! OW!

Although it’s UNUSUAL to wake up in the middle of an operation, it isn’t that rare, either.

Not to scare you or nothin’, but I’m lookin at a report in Deutsches Ärzteblatt International by Petra Bischoff and Ingrid Rundshagen. The report states that as many as one in 500 patients experience “unintended awareness” in the middle of an operation. For Massachusetts General, which does about 34,000 surgical procedures a year, that could be 78 people.

Worse for kids. Could be as much as one in 50.

Pop quiz. How many lawyers are there in the United States and what do they do for a living? (Answer: more lawyers than surgeons. More than all the doctors in the country put together. As for what they do for a living, care to guess how some of them are spending their time?)

Anesthesia isn’t just one thing. It consist of

unconsciousness (being asleep)
analgesia (doesn’t hurt)
amnesia (not being able to remember anything bad)
and temporary paralysis (can’t move)
reversibility’s good, too

All this stuff’s supposed to happen simulaneously. In fact, it’s really important that it does.

What happens when things go wrong? One possibility is that you might not be asleep when you’re sposed to be; you might feel what’s going on; you might be unable to move and,  therefore, be unable to let anyone know AND you might remember every horrible moment, later. That’s a really bad combo.

Another possibility: you might experience the pain but not recall the infinitely crappy experience. Does suffering count if you can’t remember it?

So many issues. So few trained philosophers.

Bischoff and and Rundshagen provide some suggestions to anesthesiologists and surgeons about possible steps to avoid unintended consciousness among their patients and MISTER ScienceAintSoBad fervently hopes their suggestions are heeded and lead to more tranquil surgical experiences but, all in all, MISTER ScienceAintSoBad would be a lot happier if he had never reviewed this darn paper.

Some things you just don’t want to know.

A CAVEAT

I don’t want to scare the pants off of you.

Anesthesiologists sometimes describe patients as being “light”. Doesn’t mean they’re fully awake. There’s an entire spectrum of wakefulness. Bischoff/Rundshagen describe “awareness” but don’t appear to distinguish how awake the patients are. It may well be that many of them are a little more aware than they should be but well south of  being tortured. It’s good to understand some of the things that  can happen during surgery, No need to walk around with a ripe appendix though.

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Credits for the above image (which show an operation on a US Navy ship)
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.

WORKS GOOD

Anesthesiology: With A Battery Backup

THE INTRO

Has anybody ever put you to sleep?

I KNOW you won’t be dozing while reading MY good-as-coffee articles , but have you ever been put to sleep by a white coated, caring individual who then proceeded to remove your tonsils?

FUN WITH ANESTHETICS

For medical professionals, a visit to the “Ether dome” at Mass General Hospital in Boston’s like a visit to a holy shrine. (MGH is where anesthesia was introduced to the medical world in the 1840s, in case you didn’t know.)

Ether Dome

Try to imagine a modern operation underway with a slug of whiskey dripping down the patient’s chin and four big guys holding him.her down. The doc would have – what? – 30 seconds to drag that old heart out and stuff in the new one?

Not very bloody likely!

Most of the elaborate procedures that are part of medicine, as we know it, require a peaceful sedated patient that can be kept stable for a long time. In fact, many procedures take hours. Some even take days.

Anesthesia is really one of the HUGE successes of our time. Under the command of a doctor or a nurse anesthetist at the head of the operating table, the patient’s signs are carefully monitored and the “anesthetic agents” are carefully controlled. Often, the anesthesiologist manipulates a bag, manually “breathing” for a patient whose lungs are temporarily paralyzed, watching the patient intensely for signs of  “lightening up”.

GOING UNDER

For a fun surgical experience:

1. You don’t want it to hurt (at least I don’t).

2. You don’t wanna know (unconscious).

3. You don’t want to remember it afterwards. and

4. You (or at least your doctors) don’t want you to be jerking around while tissue near nerves and arteries is being cut with great precision. So it is important that your muscles be paralyzed.

Get it all right (as well as the timing of your wake up call in the surgical suite) and, all you need for a SUPER surgical day is a nice recovery without infection. Even better would be if the hospital sends the bill to the wrong customer and – this may be TOO optimistic, the surgeons managed to remove what they were SUPPOSED to,  instead of the one on the right side.

If only the surgery were as predictable as the anesthesia.

Deaths from anesthesia happen.Nothing’s perfect. But they’re rarer than typos on Science Ain’t So Baud. Less than 1 in 100,000 procedures. RIDICULOUSLY rare!

From time-to-time, however, things go wrong enough that one of the things I mentioned above ( pain, unconsciousness, recall, or paralysis) aren’t as controlled as they  should be and a patient can have a rotten time of it.

There ARE plenty of other issues, by the way, such as “anesthesia brain” which can leave a former patient with mental deficits. However, having scared the crap out of you,  that is ENTIRELY off topic. Another time, maybe.

THE MACHINE

Anyway, getting, finally, to the point, a group from the University of La Laguna (it’s in the Canary Islands) is reporting that it has an anesthesia machine that “closes the loop”, monitoring patients and adjusting the anesthetic as needed.

Adding control to an anesthesiology machine isn’t galaxy shaking. The idea’s been around. Cooper and Newbower (Mass General Hospital) were doing this stuff in the 1970’s and Aspect Medical has been selling “Bispectral Index Monitors”  for years. (They figure out if you’re sleepy enough).

But closing the loop – letting the machine take control – is a dramatic step.

MISTER ScienceAintSoBad doesn’t think’s anesthesiologists will be going out for coffee during the procedure for a few years.

Not if I’m on the damn table!

The way it’s shaping up is this. Computers are better at doing things fast and not losing track of details. But people have got that wisdom thing going and, of course, there’s STILL that Jobs, Jobs, Jobs thing to consider. So, I guess you could think of the anesthesia machine as a truly expensive set of antilock brakes that still need a driver.

This is just a beginning. The machine has only been tried with profol and on a small number of volunteers. But it makes sense medically and scientifically.

It’ll happen.

ScienceAintSoBadRating = 7 .

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