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Surgeon Makes Tutorial DVD For Conscious Open-Heart Surgery

samzenpus posted more than 4 years ago | from the looks-easy-enough dept.

Medicine 170

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."

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Would you like to be awake for this procedure? (4, Funny)

istartedi (132515) | more than 4 years ago | (#30697298)

Doctor: Would you like to be awake for this procedure?

Patient: WTF???

Re:Would you like to be awake for this procedure? (3, Funny)

gstoddart (321705) | more than 4 years ago | (#30697376)

Patient: WTF???

My thoughts exactly.

I'm sure there's probably some valid medical reason for doing this -- I just have no idea of what it is. I don't want to be awake when the heart-rate monitor goes to a flat tone. Well, I guess you'd no longer be awake at that point, so it's moot. ;-)

Cheers

Re:Would you like to be awake for this procedure? (1)

Monkeedude1212 (1560403) | more than 4 years ago | (#30697432)

Patient: WTF???

My thoughts exactly.

I'm sure there's probably some valid medical reason for doing this

It makes the patient sound like a BAMF.

"Yeah I had open heart surgery. Got to watch the whole thing. In fact, the Doctor and I made jokes throughout the whole procedure.
'That's not a tumour, thats my wife!' "

Re:Would you like to be awake for this procedure? (3, Funny)

sycodon (149926) | more than 4 years ago | (#30697468)

Dr.: WTF?
Paitent: Huh?
Nurse: Ohh...that's isn't good.
Patient: WT.......

The incision should be made below the blockage! (0)

Anonymous Coward | more than 4 years ago | (#30697936)

Narrator: [on TV] ...and then, you make the incision below the collarbone.
                [splurt]
Dr. Nick: Oh, no. Blood!
                [screen fritzes into a cheezy talk show]
Dr. Nick: Oh, no, someone taped over the end of this!

Re:Would you like to be awake for this procedure? (4, Informative)

MightyMartian (840721) | more than 4 years ago | (#30697644)

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.

Re:Would you like to be awake for this procedure? (2, Funny)

clone53421 (1310749) | more than 4 years ago | (#30698020)

Plus, a conscious patient can tell you if something starts going wrong.

And in worst case (1)

DrYak (748999) | more than 4 years ago | (#30698424)

And in worst case, a patient who doesn't want to follow and pay attention to the whole procedure, can be given a mild sedative.

The patient will be calmly dozing during the procedure, but it's still not a general anesthetic (= which is controlled coma), only a patient having a nap during a locals (= can be wakened up, or will wake up in case of something hapening).

Commonly done in orthopaedic surgery (= epidural or nervous bloc + mild sedative).

well (1)

fireylord (1074571) | more than 4 years ago | (#30699070)

not really, unless said patient has some kind of advanced central nervous system that puts a readout in his vision of whats going on for example Blood Pressure Heart Rate Time since last dump etc etc

Re:Would you like to be awake for this procedure? (2, Interesting)

Rich0 (548339) | more than 4 years ago | (#30699250)

Yup, my friend had a stent placed in a carotid artery while awake for precisely this reason. They apparently like to assess your mental state while it is going on to detect strokes immediately.

They do tend to dope you up quite a bit though, mainly to avoid anxiety and they don't want you squirming while they put a 2mm piece of tubing in a largely-clogged artery servicing your brain via a catheter that extends from your leg to your neck...

Re:Would you like to be awake for this procedure? (0)

Anonymous Coward | more than 4 years ago | (#30698644)

And then there are people like me with other complications who have a 50%+ chance of dying under general anesthesia.

Re:Would you like to be awake for this procedure? (3, Informative)

pz (113803) | more than 4 years ago | (#30699228)

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.

And the patient is far from normally conscious under procedures like this. They are sedated, whereby it's generally meant the patient is socked to the gills with drugs like benzodiazepines.

As a gross generalization, I find that the medical profession (and I'm on the fringes of it) tends to overmedicate when it comes to sedation. As one example, my father was going to have a small bone spur removed from a toe. Yes, that can be painful, but a good circumdigit block with lidocaine will fix that. But he was supposed to be sedated for the procedure sufficiently that he would not be able to drive himself home. He called me to arrange for a ride before the fact, more than a little annoyed that a 10 minute procedure would entail such an ordeal, and I replied, "well, just refuse the sedative." He did, and was fine.

Now fixing a toe is very different from open heart surgery. The so-called awake patient during open heart surgery likely will be only slightly topside of conscious. However, there's a big difference between that and the deep general anesthesia that would be required without local anesthetics to block the pain. One of the big reasons for using less anesthesia is basic danger, as other posters have commented. But as we learn more about general anesthesia, and specifically in relation to open heart surgery, there's a significant toll it seems to take on the mind. It's considered a dirty little secret that patients are waking up after major surgery a little dumber than they were before. And, by "dirty little secret," I mean, it's an area ripe for significant research into the improvement of health care. In any case, combining a good epidural block with sedation to achieve the same surgical plane (that's the term used to describe depth of anesthesia) as previously achieved with general anesthesia is going to be a good step forward.

Re:Would you like to be awake for this procedure? (5, Interesting)

tugboat0902 (1339165) | more than 4 years ago | (#30699234)

I cannot imagine anything more dangerous than a 'neck down' regional anesthetic. Now, IAAA (I am an anesthesiologist) and from my experience, the risk of a general anesthetic for open heart surgery would be far less than the risk of this. In order to be high enough, the block would have to deprive the patient of one remarkably important activity involved in being awake, the ability to breathe. Additionally, if a selective block could be done that would permit enough muscle strength to breathe, there are serious problems in trying to breathe with an open chest. Without a sealed cavity, the lungs simply collapse. If the surgeon could stay extra-pleural, and you had a remarkably healthy and motivated patient it possibly could be done, I just cannot imagine why. Maybe this was all explained in TFA, but this is slashdot after all........

Advantage? Yes. (2, Informative)

gbutler69 (910166) | more than 4 years ago | (#30697732)

Full (unconscious) anesthesia is dangerous. That's why a special doctor (anesthesiologist) is required to be present to monitor during the entire surgery. Being awake is safer.

Re:Advantage? Yes. (1)

nschubach (922175) | more than 4 years ago | (#30697848)

It's safer unless you are me and imagine all kinds of strange things going on... and manage to pass yourself out.

I have a very low tolerance for blood, stories about it, and other detailed info on accidents, etc. I blacked out in a college speech class a few years back because someone explained his motorcycle accident. I once volunteered for a blood drive and couldn't even carry the blood pouch back to the receiving table without having to sit down in the middle of the room and handing it off to someone else.

It's making me light headed right now just typing that out.

Re:Advantage? Yes. (5, Funny)

Anonymous Coward | more than 4 years ago | (#30697950)

Too bad there's no "-1 Pansy" mod.

Re:Advantage? Yes. (-1, Troll)

Anonymous Coward | more than 4 years ago | (#30697972)

Yeah, tell me about it--some of us are just a little squeamish. I read this book [goatse.fr] after having the same problems as you, and it helped out a lot. Check it out. The eBook is free as PDF.

Re:Advantage? Yes. (1)

ckaminski (82854) | more than 4 years ago | (#30698338)

It would work better if you used tinyurl. Lol.

eBook Mirror (-1, Troll)

Anonymous Coward | more than 4 years ago | (#30698662)

eBook can be found here [tinyurl.com] since the main site appears to be down. Good luck, comrade.

Re:Advantage? Yes. (4, Funny)

Arthur Grumbine (1086397) | more than 4 years ago | (#30698118)

Do you enjoy sunbathing? If so, have you ever considered the possibility that you're a reverse vampire?

Re:Advantage? Yes. (4, Funny)

MindlessAutomata (1282944) | more than 4 years ago | (#30698626)

You'd think a reverse vampire would put blood into people, though.

Re:Advantage? Yes. (1)

Thiez (1281866) | more than 4 years ago | (#30698250)

I bet you'd be useless in a knife-fight :D

How do you feel about gore in video games (such as F.E.A.R. and Prey)?

Re:Advantage? Yes. (1)

gstoddart (321705) | more than 4 years ago | (#30698904)

I bet you'd be useless in a knife-fight :D

As would likely 95% + of the populace I'm betting.

Cheers

Re:Would you like to be awake for this procedure? (1)

calmofthestorm (1344385) | more than 4 years ago | (#30697930)

I would want to be awake honestly; the anesthesia disturbs me more than the thought of being sliced open and possibly killed. It really is a personal preference.

Also keep in mind that, while not for open heart surgery, for many operations the anesthesia is the riskiest part of the procedure; the brain isn't built to be turned on and off at will.

Re:Would you like to be awake for this procedure? (1)

gstoddart (321705) | more than 4 years ago | (#30698956)

I would want to be awake honestly; the anesthesia disturbs me more than the thought of being sliced open and possibly killed.

You'd want to be awake while someone slices open your chest and cracks your ribs apart?

You're either really brave, or a liar. ;-)

I think my squealing would be rather distracting to the medical staff. :-P

Cheers

Re:Would you like to be awake for this procedure? (1)

calmofthestorm (1344385) | more than 4 years ago | (#30699132)

Well I'm assuming powerful painkillers here, and a screen so I don't have to see it. But honestly yes.

Again, would I like to be cut open? No. But given it must happen, I'd rather be around for it.

Re:Would you like to be awake for this procedure? (1)

PPalmgren (1009823) | more than 4 years ago | (#30698128)

I'm sure some anasthetics could cause complications for at least one in a million. Even if its not the anasthetic itself, maybe someone has some serious sleep complicatins? There is never a solution to any medical problem that will work for everyone, so having multiple methods is always a plus.

Re:Would you like to be awake for this procedure? (1)

nsayer (86181) | more than 4 years ago | (#30698528)

I'm sure there's probably some valid medical reason for doing this

General anesthesia is generally more hazardous than local. I recently had surgery. It wasn't open heart surgery, but nevertheless, they wanted to do exactly what this doctor did. In the end, they decided that in my particular case (because I take blood thinners), the epidural carried more risk than general anesthesia, so they knocked me out. But were it not for that, I would have had this same experience.

When it was described to me, it was not that I would be "awake" for it, but that I'd be rousable - unlike general anesthesia, where you are totally paralyzed and they have to breathe for you and that the only way to wake you up would be to undo the anesthesia. I was told that I would feel nothing, and be groggy enough that I'd probably nap through it, but - and I'm sure this is the major difference - I would breathe on my own and not be intubated.

Re:Would you like to be awake for this procedure? (0)

Anonymous Coward | more than 4 years ago | (#30698704)

when the patient faces significant risk from anesthesia.

Re:Would you like to be awake for this procedure? (0)

Anonymous Coward | more than 4 years ago | (#30697384)

Patient: "Sure, I'll go for it. I like to watch really gross things, like those pop-a-cyst videos on youtube"

Doctor: "But we'll have a cleanroom cloth up anyway, you won't be able to see a thing. you'll just be lieing there for hours unable to move, while you hear your inards crack and squish, and smell stuff you probably thought you'd never smell in your life outside of a slaughterhouse."

Patient: "I'm a maschocist?"

Doctor: "Alright then, that makes it easier, we can skip the epidural."

Re:Would you like to be awake for this procedure? (3, Interesting)

Chris Burke (6130) | more than 4 years ago | (#30697404)

I'd do it in a second, but I'm betting they put up a screen or something below your head so you can't watch, much less put a monitor/camera above my head so I can easily see what they're doing. Which kinda defeats the purpose, from my end at least. :)

I've been given the option to be awake for several procedures, and I always say yes, but then they always change their minds at the last minute and knock me out. Maybe they're put off by how eager I sound. Kinda like when the phlebotomist is about to draw blood and sees me staring at vein on my arm, and she says "Do you want to look away?" and I go "nope!", their look changes from one of sympathy to one of being a little weirded out.

Re:Would you like to be awake for this procedure? (3, Funny)

Monkeedude1212 (1560403) | more than 4 years ago | (#30697648)

This text only interface for communication doesn't sufficiently deliver the same weird look I'm giving you right now.

I wish I had a webcam and photobucket available right now.

Re:Would you like to be awake for this procedure? (3, Funny)

corbettw (214229) | more than 4 years ago | (#30698206)

I wish I had a webcam and photobucket available right now.

How interesting, the rest of us are thankful you do not.

Re:Would you like to be awake for this procedure? (1)

Abstrackt (609015) | more than 4 years ago | (#30698232)

This text only interface for communication doesn't sufficiently deliver the same weird look I'm giving you right now.

I wish I had a webcam and photobucket available right now.

I also wish I had some kind of bucket available.

Re:Would you like to be awake for this procedure? (1)

jd142 (129673) | more than 4 years ago | (#30697844)

Yes, they most likely put up a screen. But more importantly, unless they put up a mirror, you aren't going to be able to watch the whole procedure anyway unless they prop your head up so that it would be in the surgeon's way. When someone has your heart in your hand, you don't want them to have to worry about bumping your nose.

If they wouldn't put up a mirror so I could watch my vasectomy, they sure aren't going to for a heart operation. And yes, I was awake and chatting with everyone in the room during the operation. Morphine doesn't knock you out, it just makes the pain go away.

Wierded..No (0)

Anonymous Coward | more than 4 years ago | (#30698872)

After 10 years of me injecting me for allergies, I have no problem watching what a nurse or doctor does to my skin. Cutting out or burning a wart is easy to watch but the smell of burnt me is bad.

Re:Would you like to be awake for this procedure? (0)

Anonymous Coward | more than 4 years ago | (#30699090)

You wouldn't happen to have a head frozen in your fridge by any chance?

Absolutely (2, Informative)

Theaetetus (590071) | more than 4 years ago | (#30697440)

Doctor: Would you like to be awake for this procedure?

Patient: WTF???

Doctor: We'll put up a screen so you can watch Spongebob and give you a bunch of morphine and a spinal epidural so you can't feel shiat, but if we put you completely under, your blood pressure may drop due to different autonomous reactions, and since we're doing heart surgery, that could be bad... So this improves the chances that you're awake after the operation, rather than on a slab in the morgue. Got it?

Re:Absolutely (5, Funny)

hardburn (141468) | more than 4 years ago | (#30697566)

I bet Spongebob is awesome on morphine.

Re:Absolutely (2, Funny)

insufflate10mg (1711356) | more than 4 years ago | (#30698298)

It's the best after insufflating approximately ten milligrams.

Re:Absolutely (2, Funny)

demonlapin (527802) | more than 4 years ago | (#30698828)

That's a pretty small dose.

Re:Absolutely (1, Informative)

Anonymous Coward | more than 4 years ago | (#30698732)

It's a brilliant cartoon regardless, especially seasons 1 & 2 where Stephen Hillenburg was writing the episodes.

Re:Absolutely (1)

sznupi (719324) | more than 4 years ago | (#30698172)

Morphine might work, I guess; nothing less. Otherwise I suspect the trauma of fully knowing what is happening, feeling with the part of the body that can feel anything the mere mechanical stresses, movements from opening your ribcage/etc., might be not helpful too.

Re:Would you like to be awake for this procedure? (1)

hardburn (141468) | more than 4 years ago | (#30697522)

I didn't want to be awake for getting my wisdom teeth taken out. Why would you? So you can learn about recent movements in your doctor's mutual fund account?

Re:Would you like to be awake for this procedure? (1)

Thiez (1281866) | more than 4 years ago | (#30698532)

Because it barely hurts, it's an interesting experience, and it only takes a few minutes (YMMV, but I'm sure they can give you a good estimate before they begin)? Because it's cheaper?

No. And I liked it that way. (3, Informative)

dazedNconfuzed (154242) | more than 4 years ago | (#30697650)

I had open-heart surgery. General & deep anesthesia is a wonderful thing. "Lie here ... ok ... we're going to give you a little something now to make you comfortable ..." And then I woke up a few hours later. No sense of time passing, just one moment in the OR and then the next moment I'm in the recovery room.

Now, given what happened in the recovery room, wouldn't want to extrapolate back to the idea of being awake for the procedure.
"Waking up" consisted of returning consciousness, but with no vision or hearing, and the totality of my existence being devoted to getting the breathing tube out, engaging enough self-control to know it's supposed to be there and to not panic (!!!!!), and discover that my hands were restrained to prevent acting on exactly that reaction. Then I was aware that something horrible had been done to my chest. And then ... well, it gets kinda fuzzy and unpleasant from there.

Now, if awake thru the whole procedure, that would mean not only being aware of the chit-chat ("scalpel ... clamp ... ") and other mundane activity, but the process of ramming that d@mn pipe down my throat, the sensation (however muted) of having my rib cage sawed up and pried open with a car jack, buckets of ice cubes being dumped into the gaping chest cavity, heart being stopped and partially disconnected, and generally knowing that a whole lotta things are being done to ME that are not naturally part of human existence - apart from, well, being dead (which, arguably, I was).

My wife didn't take it well in the waiting room when told "your husband is doing fine ... they just stopped his heart." Somehow I don't think I'd like being awake for observing it first-hand. And I don't think the doctors would be keen on having to watch their language/behavior knowing that the patient is watching & listening; I want them focused on the job, not on how I'll respond to their commentary.

Re:No. And I liked it that way. (0)

Anonymous Coward | more than 4 years ago | (#30698164)

Glad you got through it all OK... but I think you had the tube because of the anesthesia ... if you look at the article, the patient in this case has no breathing tube.

Re:No. And I liked it that way. (0)

Anonymous Coward | more than 4 years ago | (#30698970)

There is of course the alternative, when you aren't being given enough anesthesia and your are conscious and can 'feel' whats going on, but can't inform anyone that you are cause of the immobilization.

Had to go under for doc's to re-break my arm, remember counting down, feeling something funny happen in my arm, then waking up all groggy.

Granted mine is not even the same ball park as open heart surgery, but I'll take fully numb and awake, over immobilized and funny feelings any day of the week. That and surgery doesn't bother me. Some of the smells might, but the visual doesn't.

Point is, there's no guarantee you will be fully out when under anesthesia. And you can't really inform them of it, now can you.

Re:Would you like to be awake for this procedure? (1)

Eggplant62 (120514) | more than 4 years ago | (#30697836)

There are not enough mod points to elevate the parent post to where I'd like to see it. I'm like, "Crack my chest? I'm dead to the world, bub. I don't want to know a thing about it."

Re:Would you like to be awake for this procedure? (0)

Anonymous Coward | more than 4 years ago | (#30698012)

I sure hope this is not from the video professor. Also can you imagine laying down on the table doc asking for scalpel and hit play on the dvd? Yeah I want to be awake for that.

Where's the torrent? (1, Insightful)

Anonymous Coward | more than 4 years ago | (#30697300)

subject says it all

Hi doctor nick (0)

Anonymous Coward | more than 4 years ago | (#30697312)

HI doctor nick

Re:Hi doctor nick (3, Funny)

Anonymous Coward | more than 4 years ago | (#30697926)

Hi everybody!

Re:Hi doctor nick (1)

jhoegl (638955) | more than 4 years ago | (#30698718)

"What the hell is that?" - Dr. Nick

I was looking on Youtube for this clip, but none exists of one of the funniest moments of the Simpsons.

What's the odds... (1)

edittard (805475) | more than 4 years ago | (#30697360)

The Chinese have already pirated it?

Re:What's the odds... (1)

deglr6328 (150198) | more than 4 years ago | (#30697454)

The odds are 100%, as this has always been the ACTUAL method used by woo-woo, acupuncture, "complementary alternative" medicine peddlers who to this day are still selling the laughable fraud of "acupuncture-only [csicop.org] anesthesia" surgery.

They do this for other things too (1)

Suki I (1546431) | more than 4 years ago | (#30697378)

My friend had a Cardiac Cath examination and got to watch the whole thing on the same monitors that the cardiologists were working from. His heart was healthy and they even sent him the video on a CD!

Conscious card cath? Now THAT was interesting! (1)

dazedNconfuzed (154242) | more than 4 years ago | (#30697706)

Being awake for a cardiac catheterization is a different story. Since there are no apparent after-effects, and no slicing-and-dicing of organs, it really was fascinating to watch a live x-ray of my heart in action while feeling only a faint strange tickling in my chest. Nothing showed up wrong save the expected valve regurgitation.

Never dawned on me to ask for a copy of the video ... I'll have to ask about it.

Re:Conscious card cath? Now THAT was interesting! (1)

Suki I (1546431) | more than 4 years ago | (#30699098)

He got his done at Walter Reed (he did mention that it was an excellent facility, where he was, contrary to the news reports about other parts of the campus)

Re:They do this for other things too (1)

Chris Burke (6130) | more than 4 years ago | (#30698268)

My friend had a Cardiac Cath examination and got to watch the whole thing on the same monitors that the cardiologists were working from.

Oh hell yeah. That's what I'm talking about.

Bad Idea! (1)

Monkeedude1212 (1560403) | more than 4 years ago | (#30697390)

Have you never heard of Job Security through Obscurity?

If me and my roomates can learn to preform open heart surgery on each other - why on Earth will we need to go to a surgeon!!!

(This is a pre-emptive woosh for those of you who are about to point out the obvious)

Re:Bad Idea! (2, Funny)

gstoddart (321705) | more than 4 years ago | (#30697520)

If me and my roomates can learn to preform open heart surgery on each other - why on Earth will we need to go to a surgeon!!!

Oh, I can foresee a whole new category of Darwin awards being handed out for that one. :-P

Cheers

Re:Bad Idea! (4, Funny)

shutdown -p now (807394) | more than 4 years ago | (#30697900)

If me and my roomates can learn to preform open heart surgery on each other - why on Earth will we need to go to a surgeon!!!

Unions? ~

Beep, Beep, Beeeeeeee (2, Insightful)

gimmebeer (1648629) | more than 4 years ago | (#30697424)

Uh hey Doc, what's that sound mean? Am I gonna.....uuurgggh.

Prior Art (1)

ATestR (1060586) | more than 4 years ago | (#30697464)

Didn't the Mayan culture practice open heart surgery on their sacrifi^H^H^H^H^H^Hubjects while they were still conscious?

Re:Prior Art (1, Funny)

Anonymous Coward | more than 4 years ago | (#30697528)

Pretty sure the guy from Indiana Jones and the temple of Doom too.

Re:Prior Art (1)

Monkeedude1212 (1560403) | more than 4 years ago | (#30697576)

Ha, hahaha, ha, if you only knew what their practices were...

They used to take the poisonous tips of stingrays and jam it into their own reproductive organs.

I'd rather die by half-open-heart-surgery.

Re:Prior Art (1)

shawb (16347) | more than 4 years ago | (#30698832)

To be honest, they did get get them jacked up on coca leaves first... does dull the pain a bit.

Oh HELL no! (0)

Anonymous Coward | more than 4 years ago | (#30697540)

I once had to have a sigmoidoscopy done. There was a monitor right there and I could watch them playing cave adventurer inside my bowels. That was bad enough, no way in hell I want to be awake while they crack my chest open and screw around with my heart!

Link (1)

zlogic (892404) | more than 4 years ago | (#30697554)

Doesn anyone have the torrent link to this tutorial? :-)

about this tutorial ... (1)

buchner.johannes (1139593) | more than 4 years ago | (#30697686)

is it DIY?

You aren't exactly wide awake... (4, Informative)

sirwired (27582) | more than 4 years ago | (#30697726)

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

Re:You aren't exactly wide awake... (3, Interesting)

Hurricane78 (562437) | more than 4 years ago | (#30697828)

From what a nurse told me, it’s just that the narcotics have a very small area between “doesn’t do anything” and “kills you instantly”. So it’s very hard to get it right.
Which is why still so many people die in the process!
Especially older people often simply go crazy from it. And die more often too.

She told me, from her experience, that whenever you can, avoid full narcosis at any cost! It’s very far from the convenient trick to get around experiencing it. The one deciding on the dose sweats blood and tears because every time, he makes a decision that can kill you.

Re:You aren't exactly wide awake... (5, Informative)

demonlapin (527802) | more than 4 years ago | (#30698798)

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 [apsf.org] 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 [lifelineto...dicine.com] .

Re:You aren't exactly wide awake... (1)

EatHam (597465) | more than 4 years ago | (#30698150)

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

What if I don't want to be kept from not dying?

Re:You aren't exactly wide awake... (0)

Anonymous Coward | more than 4 years ago | (#30698638)

Then you're wasting the surgeon's valuable time when you could be easily be finding a large bridge instead.

Re:You aren't exactly wide awake... (3, Funny)

MindlessAutomata (1282944) | more than 4 years ago | (#30698688)

You have a duty to your fellow man to continue paying taxes.

Re:You aren't exactly wide awake... (1)

DarthVain (724186) | more than 4 years ago | (#30698420)

Ya I also don't want to hear the doctors talking about the game last night while cutting on me...

xkcd (1, Funny)

Anonymous Coward | more than 4 years ago | (#30697790)

Can't believe it hasn't been mentioned:

http://www.xkcd.com/218/

Not for the weak of heart (3, Funny)

Rikiji7 (1182159) | more than 4 years ago | (#30697818)

It's recursive

Know-it-alls! (1)

LunarEffect (1309467) | more than 4 years ago | (#30697866)

Imagine having one of those patients who think they know everything better.

"Don't saw my rib bones like that! I'm sure they didn't do it like that on the Discovery Channel! Be careful where you poke that thing! You almost punctured my pancreas!"

That is just AWESOME (1)

amir4000 (1460933) | more than 4 years ago | (#30698000)

That is awesome!! I'm gonna add this DVD to my collection of C#, and Visual Studio tutorial DVDs... Does anyone have a Torrent link to a brain surgery tutorial?? One of my buddies needs his brain rewired and I wanna see if I can give him hand with it!

Can't wait... (1)

dos4who (564592) | more than 4 years ago | (#30698010)

..for this to show up on ThePirateBay :)

Does DVD include different Camera Angles? (1)

Tekfactory (937086) | more than 4 years ago | (#30698050)

Subject says it all, DVD has had this feature for a long time, yet there aren't really a lot of people using it.

So what if I had these extra angles? I think the whole thing is probably one giant director's commentary so that is a given.

Deleted scenes? probably not

Alternate Endings? stay with me here, I don't necessarily mean the patient dies. But since they have 10 years of experience with this procedure, what are some of the complications they've seen, what are some things to avoid.

And yes, when can I add it to my Netflix queue?

Re:Does DVD include different Camera Angles? (0)

Anonymous Coward | more than 4 years ago | (#30698566)

Yeah. And 5.1 DTS.
I can't wait for the sequel and prequels. Gawd, is there a trailer somewhere!? I'd love to see a mashup as an action flick HAHAHA

Open Heart Surgery for Dummies (1)

clone53421 (1310749) | more than 4 years ago | (#30698076)

When does the book come out?

Interesting. (3, Insightful)

demonlapin (527802) | more than 4 years ago | (#30698270)

This would be utterly fascinating to watch. I would be interested to see how he managed the patient's temperature. In patients undergoing general anesthesia for this procedure, the body is generally cooled in order to reduce the risk of tissues dying due to low blood flow, but that's not as easy an option in this case - the patients can still move their legs, for example, and shivering would be A Bad Thing, as well as subjectively unpleasant.

There's also the small matter of maintaining the integrity of the pleural space - if you expose lungs, the patient can no longer breathe. It's impressive that they've made it work.

Old people (2, Interesting)

DarthVain (724186) | more than 4 years ago | (#30698392)

The reason why this is big news is that some people (mostly old people) who get knocked out, never wake up again, and it has little to do with the surgery itself but with the drug induced unconsciousness. Having a method or ability to do this without knocking someone completely out would reduce risk for those in the high risk to die while under. This is why you always have to sign a consent form when getting a general. I had some oral surgery a couple of years ago in my late 20's and I still had to sign a bunch of stuff that says I am aware of the risks and that I might die from being knocked out, and please do not have your relations sue us if that is the case. Now if your in your 80's and have the same procedure, it might be better to keep you awake during the procedure.

(I was awake for the "tooth extraction" which translates to the most horrific medieval hammer and fscking chisel, and horrible horrible sounds and pressures you do not want to remember. So when it came time for the "tooth implant" I decided to get knocked the heck out. It cost me an extra 300$ bucks I think, but I was not going through that nightmare again. Not sure if it was as bad, but I wasn't taking any chances. If I had to do it again, I would have had them knocked me out for the "extraction" and would recommend anyone who has to get a tooth implant in this fashion do the same.)

However when I read the title I envisioned the surgeon performing open heart surgery on himself while awake... now that would take some balls!

Re:Old people (2, Insightful)

Cyberax (705495) | more than 4 years ago | (#30698588)

"I was awake for the "tooth extraction" which translates to the most horrific medieval hammer and fscking chisel, and horrible horrible sounds and pressures you do not want to remember."

Try tooth extraction without anesthesia someday. Now that's an experience (yes, I know it firsthand).

Re:Old people (1)

DarthVain (724186) | more than 4 years ago | (#30698924)

Well there is extraction and extraction.

Technically I could "extract" some teeth by punching someone in the mouth or a similar traumatic impact or accident.

The best as I can describe it (and this one all of one tooth), was that the had me lie down, and froze the bajesus out of my face.

They then put a cloth over my eyes (so as to not get tooth chunks in them? I suspect simply so I could not see and panic), but I could still see out at a hard angle looking straight down.

The dentist kept saying "your going to feel a little pressure..." and I am not sure I would call it pressure, or little.

They basically used a thing that looked like a wood chisel with a slimmer blade and all metal, and a freaking mallet.

Occasionally the blade would get stuck in the gum/tooth or more likely the bone, and he would have to work it back and forth to free it so that he could attack it again.

They had a nurse with suction, and a towel on my chest for stuff which got pretty bloody.

After that they drilled a hole in my jaw, which aside from the vibration through my skull and the smell of burning me wasn't too bad. They they took a bone matrix or lattice and stuffed the hole with that to strengthen the jaw at that point. That also was not a big deal, mostly him shoving it in there with his fingers and applying a lot of pressure. They then stitched me up... which was awesome, because I knew they were done with me!

Just thinking about it gives me the willies.

Re:Old people (1)

Cyberax (705495) | more than 4 years ago | (#30699300)

I had a molar extraction without anesthesia when I was a kid. The doctor injected several doses of novocaine but without any effect.

So the doctor had to extract tooth with me fully conscious and two nurses holding my hands :) It was not that bad, just about 10 seconds of blinding pain.

Re:Old people (1)

ParanoiaBOTS (903635) | more than 4 years ago | (#30699230)

"I was awake for the "tooth extraction" which translates to the most horrific medieval hammer and fscking chisel, and horrible horrible sounds and pressures you do not want to remember."

Try tooth extraction without anesthesia someday. Now that's an experience (yes, I know it firsthand).

I know what you mean, I will never, ever forget that god awful noise as they pry a tooth out of your head (it was akin to pulling a rusty nail out of a board)

Re:Old people (1)

bigstrat2003 (1058574) | more than 4 years ago | (#30699362)

I had both my lower wisdom teeth taken out with just a local anesthetic (since it was cheaper and I didn't need a ride afterwards). It really wasn't bad (except for when I had the second one done, they didn't give me enough anesthetic at first which hurt like a motherfucker). They took what sounded like a small rotary saw and used it to cut the tooth in half, and then pulled it out. It feels pretty damn weird to have someone tugging on your jaw that hard, simply because your brain is going "this should hurt", but it doesn't actually hurt. It wasn't really all that unpleasant, though.

Now granted, the pain from the second time before they gave me enough anesthetic pretty much guaranteed that I'll get put under if my top wisdom teeth have to come out. A mistake like that probably won't get made again, but damn, it sure hurt bad enough to make even a small risk of that level of pain worth avoiding.

Re:Old people (1)

nsayer (86181) | more than 4 years ago | (#30698614)

Mod parent up! I'll second his story. When I was a teenager, I went to the dentist thinking I was just getting a cleaning, when he started extracting a wisdom tooth! Not only did I not know he was going to do it, but by the time he started and I figured out what was up, there was no turning back. I had them knock me out to get the other three. Never again!

Re:Old people (-1, Troll)

Anonymous Coward | more than 4 years ago | (#30699044)

The reason why this is big news is that some people (mostly old people) who get knocked out, never wake up again

Under ObamaCare, we call that "elective costs savings."

The date of the article (0)

Anonymous Coward | more than 4 years ago | (#30698894)

This article was in the print form from Feb 09 and was recently made available online Dec 09. This has now been /. 1-8-10, is /. becoming slow with news articles?

Quote from article:
"Wide-awake heart surgery
By Tom Cheshire|21 December 2009

This article was taken from the February issue of Wired UK magazine. Be the first to read Wired's articles in print before they're posted online, and get your hands on loads of additional content by subscribing online"

Re:The date of the article (0)

Anonymous Coward | more than 4 years ago | (#30699030)

Seems I was wrong about the month the issue came out, it seems to be the Feb '10 issue.

grey (1)

tokul (682258) | more than 4 years ago | (#30699198)

Surgeon decided that learning from Grey's Anatomy is not good enough.

I would HOPE the doctors would be conscious... (1)

thedbp (443047) | more than 4 years ago | (#30699244)

I would HOPE the doctors would be conscious during this kind of surgery.

Oh, wait, what?

Nevermind.

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