Re: Finger Surgery..Dr Moulden answers ;-) and medline link / emedicine

[Guest guest]

There are always small risks for any surgical procedure and general

anesthesia. Your anesthetist will review these with you:

Some inlcude:

General anesthesia

General anesthesia uses drugs administered systemically to render the

patient unaware of anything that is being done to or around him or

her. It must be safe, not threatening or unpleasant to the patient,

allow adequate surgical access to the operative site, and cause as

little disturbance as possible to internal homeostatic mechanisms. A

point worth noting is that general anesthesia, as opposed to local or

regional anesthesia, may not always be the best choice. The

anesthesiologist selects the optimal technique for any given patient

and procedure. Attributes of general anesthesia include the following:

* Advantages

*

o Makes no psychological demand of the patient

o Allows complete stillness for prolonged periods of time

o Facilitates complete control of the airway, breathing, and

circulation

o Permits surgery to take place in widely separated areas of

the body at the same time

o Can be used in cases of sensitivity to local anesthetic

agent

o Can be administered without moving the patient from the

supine position

o Can be adapted easily to procedures of unpredictable

duration or extent

o Usually can be administered rapidly

* Disadvantages

*

o Requires the involvement of an extra set of healthcare

providers

o Requires complex and costly machinery

o Requires some degree of preoperative patient preparation

o Usually associated with some degree of physiological

trespass

o s the risk of major complications including death,

myocardial infarction, and stroke

o Associated with less serious complications such as nausea

or vomiting, sore throat, headache, shivering, and delayed

return to normal mental functioning

o Associated with malignant hyperthermia, a rare, inherited

muscular condition in which exposure to some (but not

all) general anesthetic agents results in acute and

potentially lethal temperature rise, hypercarbia,

metabolic acidosis, and hyperkalemia

A given patient's risk for complications as a direct result of general

anesthesia is small but depends largely on his or her medical

comorbidities. The anesthetist will check the patients oral airway

before anesthesis in the pre-op phase to ensure easy access to

intubation (the tune that is placed in the lungs to breath for the

patient while in surgery as the anesthetsia suppresses the muscle

control of the diaphragm which allows breathing to occur). If the

airway is " tight " , the anetshtists will ensure to have a " difficult

intubation tray " on hand during the intubation phase for " rapid

intubation. "

The anesthetist hyper-oxygenates the patient before attempting to

secure the airway after the individual has been placed under general

anaesthesia (and no longer breathing on their own). Dentures are

removed prior to anethesia as they can interfere with intubation -

however, this clearly will not be a problem with a child ;-)

Death attributable to anesthesia is said to occur at rates of less

than 1:10,000, but these are average figures incorporating both

elective and emergency patients with all types of physical conditions.

Minor complications occur at predicable rates, even in previously

healthy patients. The frequency of symptoms during the first 24 hours

following ambulatory surgery is as follows:

* Bleeding, vomiting, nausea - Less than 5%

* Fever - 5-15%

* Dizziness, headache, drowsiness, hoarseness - More than 15%

* Sore throat - 25%

* Incisional pain - 30%

An excellent recent review of the literature concerning

anesthesia-related morbidity and mortality will be of interest to

readers wanting more information.1

1. K, Baker AB. Consent and anaesthetic risk. Anaesthesia. Oct

2003;58(10):962-84. Medline link is below: link :

http://www.medscape.com/medline/abstract/12969038?src=emed_ckb_ref_0

Cordially,

Dr Moulden BA, MA, MD, PhD

1-705-498-6284

drmoulden@...

addendum: We have also found that leaches placed on the finger, by

virtue of their secreting anti-coagulants (hirudin), is quite helpful

at saving a severed/traumatized digit (finger) from loss or gangrene

as opening the microvascular capillary beds is critical to tissue

repair the body will impose naturally..imagine that.

> > Hi, I got some sad news today. I was hoping my son's fingertip would

> > reattach after a door-slamming accident, but it didn't and there is

> > exposed bone. The orthopedic doc said the only thing to do is break

> > the bone and sew the tissue over it in surgery. He would have to get

> > anesthesia. I asked him if there was any other way and he said

no. Is

> > there anything I should be concerned about with anesthesia safety?

Are

> > there different kinds? Help, I am scared, none of us have ever had

> > surgery!

> >

> >

> > ------------------------------------

> >

> > =======================================================

> >

[Guest guest]

Thank you. My son may have low blood sugar during the procedure

because (he has to fast), is that a concern? He doesn't have a

hypoglycemia diagnosis, but I recognize the symptoms of it from time

to time, especially on taurine or ALA.

> > > Hi, I got some sad news today. I was hoping my son's fingertip

would

> > > reattach after a door-slamming accident, but it didn't and

there is

> > > exposed bone. The orthopedic doc said the only thing to do is

break

> > > the bone and sew the tissue over it in surgery. He would have

to get

> > > anesthesia. I asked him if there was any other way and he said

> no. Is

> > > there anything I should be concerned about with anesthesia

safety?

> Are

> > > there different kinds? Help, I am scared, none of us have ever

had

> > > surgery!

> > >

> > >

> > > ------------------------------------

> > >

> > > =======================================================

> > >

[Guest guest]

Thease are issues that will all be covered in your pre-op consult

with the out-patient sugical team and the anesthetist.

Your soien wil, have an IV (intravenous) line (a couple likely)

during the general anesthesia procedure.

The IV solutions the Anetshtists has to choose from includes normal

saline (salt water in concetratuins that exist normally in our

bodies), or D5W (which is dextrose - a sugar based IV solution).

Your son is required to fast the night before as the anesthesia, or

intubation, can trigger a reflux of gatsric contents, which, whie a

person is under genearl anetshesia, can be aspirated and end up in

the lungs if the person vomist - from intubation or from anesthesia

to a certain extent. During the genera nesthesai and post-op period,

a person is not in te best position to protect thoir own airway..so

please ensure that you do not allow anything by mouth and fast as per

the day-surgery gudilines you will receive.

Without a history of diabetes, fasting for 12 hours before surgery

will not result in significant hypoglycemia to be of any concern

during this procedure. Simply make note of yur concerns to the

anesthtist during the pre-op conslut just prior to surgery and this

concern will be adequately addressed for you;

Fasting is not a risk factor for adverse outcome from surgery under

genera anesthesia.

Excellent question though.

Please note that many of your answers you seek, more times than not,

can alweays be found at the emedicine site - this is information that

decribes many condictions of emergency and general practice medicine.

The med-line links are generally a bit " techy " and geared to

physcians and specilaists.. the medcine links balance medcial,

Doctor, and layperson information.

I hope this was helpful.

I hope the emergentologist at least placed some sticthes and dresing

in this wound; getting caught in the door is certainly better than

getting caught in someone';s teeth ;-)

Dr Moulden,

> > > > Hi, I got some sad news today. I was hoping my son's

fingertip

> would

> > > > reattach after a door-slamming accident, but it didn't and

> there is

> > > > exposed bone. The orthopedic doc said the only thing to do

is

> break

> > > > the bone and sew the tissue over it in surgery. He would

have

> to get

> > > > anesthesia. I asked him if there was any other way and he

said

> > no. Is

> > > > there anything I should be concerned about with anesthesia

> safety?

> > Are

> > > > there different kinds? Help, I am scared, none of us have

ever

> had

> > > > surgery!

> > > >

> > > >

> > > > ------------------------------------

> > > >

> > > > =======================================================

> > > >