Heart surgery performed in awake patients

[LUVMyBirman]

Interesting....I can't even imagine...or want to. Give me the drugs please!


Nov 24 (Reuters Health) - Heart surgery is a frightening prospect for many people, but now imagine undergoing the operation completely awake! That's what seven patients treated at a hospital in Turkey went though -- in a planned, deliberate study.

This wasn't some anesthesia horror story, but a procedure that was designed by the surgeons. The results indicate that coronary bypass surgery can be safely performed in awake patients, even if they have relatively severe heart disease.


Although the patients did not receive general anesthesia, they felt no pain during the surgery thanks to epidural anesthesia -- the type usually given to pregnant women during labor.


So why would anyone want to undergo heart surgery awake? For one thing, general anesthesia carries its own risks. Also, unlike conventional bypass surgery, the awake version of the operation used in these cases did not require the use of mechanical devices to do the work of the heart and lungs, which can cause serious complications.


The technique of awake heart surgery was actually developed a few years ago, but Dr. Kaan Kirali and colleagues, from the Kosuyolu Heart and Research Hospital in Istanbul, modified the procedure slightly and tested it on seven patients with blockages in two or three of their coronary arteries, the blood vessels that feed the heart.


The researchers' findings appear in the Annals of Thoracic Surgery.


All of the patients remained conscious throughout the operation and none had to be switched over to a more conventional procedure, the authors note. Moreover, none of the patients experienced a heart attack or died during or shortly after surgery.


Three patients developed a collapsed lung during surgery, but it was repaired in two. The other patient completed the operation with the collapsed lung.


While the findings may stimulate interest in awake heart surgery, don't expect an immediate upsurge in such operations. As Dr. John Puskas, from Emory University in Atlanta, notes in a related editorial, the popularity of this procedure will be limited until a study is performed comparing its benefits with that of conventional heart surgery.


SOURCE: Annals of Thoracic Surgery, November 2004.

 

[geebee]

I think I would need a padded cell after such an operation. Just the thought of hearing the saw......
Smiles (sort of),
Gina

 

[SHerrin Hutt]

Both of my surgery for the implant of the ICD I was given versed but this does very little to me so I remember everything that is going which is not not a good thing. All the TEE I have had I can tell you everything that went on. The drugs just don't seem to work on me. I guess because I have had so many things done. I much rather be put out but they just don't understand that the drugs just don't effect me like others.

 

[LUVMyBirman]

Sherrin,

I react the same way to Versed. Hate the stuff. It works so in reverse...that hours later I am sleeping at the drop of a hat. It keeps me down for at least two days. No driving.

They now have allergy marked in bold on my chart. Wonder what they can do for me in the future? Have been noticing that it takes an awful lot of novicane to numb my mouth during a dental proceedure as well

Ps. Gina, the dental saw was enough for me. Could not even imagine

 

[Karlynn]

Sounds like something developed by Hannibal Lector. No thank you!

 

[Gnusgal]

Versed works great for me. It's vallium that I have marked as an allergy now. I was wide awake through my 3rd pacemaker surgery and remember every moment (hadn't discovered versed yet). There's no way I would want to remember open heart!!! Yeesh, just the thought gives me the heebee-jeebees!

 

[Les]

Fully Awake OHS

Fully Awake OHS

It would be beneficial as far as a quicker recovery, but the terror of hearing someone say "Whoops" or "Uh-Oh" is reason enough to be out completely!

 

[Ross]

I simply refuse to even fathom the idea!

 

[Georgia]

I had a lumpectomy done with a local; it was my choice and I wouldn't make the same decision again. Don't like the "squish squish" noises; don't like the sounds of the docs when they find something they don't want to find; can't imagine what it'd sound like when they're attacking the sternum, etc. UGH UGH UGH.

I'm all for many many drugs.

 

[Harpoon]

geebee>>I would DEMAND to have a CD player with headphones and the LOUDEST, music in my collection, all the heavy industrial/techno and my Chili Peppers and Fishbone... It would be loud enough for everyone in the room to hear and it's gotta STAY that way!!!

Sherrin, Gina, whomever else>>It takes a few shots in the dentist chair for me as well. My dentist starts out "prepared" for it giving me two shots right away just because he knows and then he goes off to check on another patient. He'll come back a few minutes later, check around and give me another shot if I can still feel stuff. Usually takes only an hour or two to wear off too.

I had an epidural when I had a hernia repair done a few years ago. We had talked about the risks of going under general with my heart and decided to try the epi along with light sedation and see how it went. Unfortunately, things didn't work out and I ended up under general but I had a cardiologist monitorning me the whole time and came out fine save for a bloody nose. (for some reason, I've had a bloody nose every time I've had surgery since the hernia repair, which has been several times now thanks to my Cleveland Clinic visit....)

 

[bvdr]

Anesthesia or pain meds don't work very well for me either sometimes. One of my doctors up at Duke mentioned to me that I tried to wake up on them during my OHS. I find that Aspirin and Tylenol work about as well for me as Percocet or some of the other meds.

I once read a study regarding a genetic mutation that affected how a patient reacted to pain medication. I ran across it during valve research and it seems that there may be a connection somehow.

Once I was under a regional anesthesia (where just the limb affected is anesthetized) for some ankle surgery and there was too much commotion in the operating room. My ortho surgeon lost his temper and threw his scapel on the floor and announced he wasn't going to go any further until the commotion stopped. My anestheologist asked if I wanted to go out. I said I sure did. I missed the rest of the scene but I heard later that the arguing continued for a while. I prefer to read about the operation later.

My husband thought maybe the Turkish study used Greeks for their patients.

 

[Gnusgal]

The one time that I was awake for surgery (the pacemaker replacement) was not completely intentional. They were supposed to give me enough sedative to make me sleep (or so I was told) through the surgery. However, having not been told that this was what they were going to do until 10 minutes prior to the surgery, the agitated state I was in was barely dented by the drugs they gave me. Every time they came to check on me after having given me more vallium I would say "I'm not out yet, you'd better give me more drugs." I did NOT want to be awake. I knew this, and made it very clear. However, they kept giving me more and more vallium, and I just kept getting more and more agitated (they finally switched to something else, but I don't know what). I was awake as they numbed the area (talk about weird feeling!), and somehow drifted off for just a little bit before I was jolted back awake when they inserted the temp. pacer wires and I began to twitch! Fortunately (for all involved) I did drift off for the actually cutting of my skin. I'm not sure what I would have done to my cardiologist if I'd been awake for that (my card was doing the surgery, not a surgeon, which was another suprise to me that day). I woke back up not too long after that, though. I remember feeling him remove the old pacer and place the new one, screwing the leads into the new device (cleared up one mystery). Then I felt him start to sew me back up. I was groggy enough to not move or say anything. However, when I heard him say "This isn't going to close, I'm going to have to use staples" I shouted (or at least, tried to shout) "I don't want staples!" (of course, as groggy as I was, it came out more like "Idonwansapls." I took them all by surprise. A nurse poked her head around the sheet and asked me what I had said. I repeated my slurred words. My card said "Well, I'll see what I can do, but I think you may have no choice." I got staples.

Needless to say, I was VERY upset with my cardiologist that day. And the vallium helped me to tell him exactly what I thought of him. (This is not the cardiologist I have today. She would never put me through such a traumatic experience.)

I now tell people I'm allergic to vallium. However, if I have to be sedated nowadays, I ask for versed by name. Man, that stuff is a miracle drug! One second you're there, and the next you're still there but don't remember a darn bit of it!

 

[Guest]

Eegads.

*eyes pop wide open*

I'm not sure I could do that....

*pauses to recall vivid memory*

Once upon a time, during one of my catheterizations, I woke up in the middle of it. Boy, was that SCARY. I was awake enough to hear the docs talk, but I wasn't awake enough to figure out how to alert them that I was awake. IIRC, one of 'em noticed my eyes open and quickly administered more drugs.

*shudders*

Eewww...such a memory.


Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72/'6/'9/'81/'7, train/models = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html

 

[SHerrin Hutt]

I guess I just one of though people none of the drugs work. I have many TEE's, Colonoscopy , EGD's & heart cath's and was awake through them all! I would yell I was in pain but no one payed any attention. After my first Tee, When the Dr. was walking away he told the nurse he would come back and talk to when I was awake but to his suprise I spoke up to tell him I was never out and I would like to do the same to him! I told him I felt like he had put a garden hose with a rake on it down my throat and I was not a happy camper. I remember the one in 2002 when I had the stroke and the Dr. told my family I took it well. But he must have been in a different room then I was . I lost my dinner from the night before and lost control of my bladder. If that wa handeling well what was the worst case(death). I would like to perform theses tests on some theses Dr's just so they know how it feels.I don't think they have a clue. Thanks for letting me vent!

 

[Harpoon]

Needless to say, I was VERY upset with my cardiologist that day. And the vallium helped me to tell him exactly what I thought of him. (This is not the cardiologist I have today. She would never put me through such a traumatic experience.)

Heehee! Being on POWERFUL drugs give you free license to say whatever the HELL is on your mind!!!

Just too bad we can't remember most of our spouting off afterwards.

I've been told on several occassions that I had a "habit" of flipping the bird whenever my nurses did something I wasn't thrilled about back in the day before I could remember anything... I gather I did this several times while intubated and even tried to spell out f*** y-o-u on a note pad my wife had written out the alphabet on so I could spell out something that wasn't on the other sheet she had written "common phrases" on so I could communicate by pointing...

I also had a habit of trying to break limbs. Apparently I had a death grip of a hug back then when my family first came in to see me during a visit and I kicked my brother a few times pretty hard.


Of course, I remember none of this now...

Oh darn... =(


Vicodin was the "happy drug" of choice after I had my hernia operation. I didn't take it much after the first day really because it knocked me out HARD and I wasn't really bothered by the surgical site after the second day. I did take a dose about four days later when I was home alone with my son and this terrible pain started up through my leg and into my back. Like a delayed reaction to the spinal tap/epidural or something. I was buckled over on the floor in the living room reeling with my son nearby when my father came in to help me after I had called him at work. I sent him right off to the bathroom for the pills and something to take them with then, after slugging down the happy pill, he helped me get to bed and stayed to watch the kid while I went night-night....

I think actually that's the worst pain I've been in in recent memory, that I remember anyways. There is that 5 week period after my second OHS that's all but a mythical adventure to me....

 

[Lisa in Katy]

I once saw an article about people having open heart surgery without any type of anesthesia. The doctors used acupuncture instead. This was in an Asian country, although I can't remember which one now. It was in a medical journal, so I assume it was true.

I woke up soon enough from my surgery - in time to eat dinner that evening. I'm also one that pain meds don't work well for. I took Vicodin every 4 hours, alternating with Tylenol, when I had pericarditis, and was able to drive 35 miles each way to work.

 

[Harpoon]

Yeah, that's been done before on a number of different types of surgery...


But it takes a few weeks or more of practice and meditation before surgery to actually do without screaming bloody murder the whole time....

Altered mental state. It's really cool what the human mind is capable of at times, but not everyone has the self-discipline to do it.

 

[Abbanabba]

That is just NASTY!!!!!!!!

I'm the sort of person who'd take a general for a blood test if I could..... if only it didn't have to be administered by needle!!

Sadly I've also got quite a high tolerance to drugs. I remember when I was a kid I had to have some major dental done under general..... they gave me a dose of "knock-out" drugs, came back about 15 minutes later to find me playing, gave me some more drugs and I STILL woke up during the procedure (..which I remember quite vividly - and at that point I think I got injected with something else..).

Having this happen if (when) I go in for OHS is one of my biggest fears and I'm always sure to ask for a little "extra" when I'm having something done. I think too I look quite small for my body mass (people never believe how much I weigh) so perhaps I get doses based on what they think is appropriate..... I don't know.


Harpoon - had to laugh at your story!! Last time I had some serious drugs (for a wisdom tooth extraction) I was apparently quite "beligerent" after the fact. I don't remember any of this of course, but my poor flat mate relayed the events the next day for which I was most apologetic!


A : )

 

[tobagotwo]

They can do OHS on me while I'm awake, but only if I get to watch...