Saturday, January 12, 2013

How does it feel when you have surgery with a retinal detachment?

Q. I am 15 years old and I am scared. I got this retinal detachment, the doc. says, by a trama accident when I got hit in the eye 3 months ago. He says he has to cut also the membranes or something like that that is pulling the retina.

A. you don't feel a thing, they either give you a general anesthesia, so you sleep thru it, or they use numbing agents and again, you can't feel anything.


Which anesthesia should I use for my rhinoplasty?
Q. I have the options of local or general.

I know the main difference between the two is that local is just for the specific area that's going to be operated on & the the general produces a state of unconsciousness.

I know general is much more expensive, so I would like to know what the procedure would be like if I decided to go local.

Would I be "awake"?
Would I be able to look around & feel everything?

I really don't know, so thanks for any advice you can give.

A. Rhinoplasties often involve bone chiseling, and you'll feel the hammer and chisel as the surgeon works if that is part of the plan. Ask you surgeon for more specifics. If it's just some tip work, then you'll be fine with local. (And yes, you'll be wide awake and know what is going on)

You won't see much because there will be a head drape and probably some gauze over your eyes so the light doesn't bother you. (If you are asleep, we tape your eyelids shut to prevent corneal abrasions)

The first procedure I scrubbed in on as a med student was a rhinoplasty. It's not delicate surgery. I got to tap the chisel with the little mallet. Since then, I've given anesthesia for a fair number of them, almost always general, but we do a few under local with deep sedation. (If you have an anesthesiologist, the cost is the same regardless of the technique used).


What is the difference between sedation and general anesthesia?
Q.

A. Sedation is just as the name implies. You are sedated but not unconscious. An example of sedation would be a benzodiazepine such as alprazolam, temazepam, etc. Sedation is used for less invasive procedures or even testing. IE: You would likely be given the option to be sedated for an MRI scan, or something like Laser eye surgery.

However, general anesthesia is the full deal. You are unconscious and you are intubated. Intubation is the process of inserting tubing into your lungs and having a machine breath for you. In general anesthesia you are given a cocktail of medications that not only put your to asleep, but kill pain and cause hypnotic effects -- where you usually don't remember a thing except the moment just before the I.V. started going and they told you goodbye (or in some cases the inhaled anesthesia). I.V. is the most widely used in modern medicine.

General anesthesia is used for more invasive purposes.. for most often surgery. Anything that takes more than a few minutes to perform or needs absolute stillness and control of bodily output is going to be using GA. Some surgeries use local anesthetics,.. and some nothing at all.

An example of a fairly painful surgery that often uses nothing is a hemodialysis neck catheter. If the vascular surgeon (or other general surgeon) is confident enough in his technique then it isn't uncommon for them to take a scalpal and slice directly into the side of your neck into your artery and run rubber tubing ports all the way to your heart, insert the catheter on top of this and apply a few stitches -- all without any sort of sedation, anesthesia, etc. It only takes, with a good surgeon, 5-10 minutes at the most to perform this. There is always a risk with General Anesthesia of death. Some people do not come out of the 'sleeping' phase as intended, and others die from the anesthesia for a variety of reasons.. so if it doesn't have to be risked it isn't.


Is this a normal outcome for a simple surgery?
Q. My mom had to have surgery yesterday, it was to remove a lump from the right side of her neck, she had iv sedation, not general anesthesia, upon waking up from it, her eye was in terrible pain and the doctors said it was a corneal abrasion, she has a an eye patch and medicine she needs to put in every day, the doctors say the "do not know how this could have happened". she is in more pain from her eye than she is from her actual surgery. is this typical and is there anything else she should do?

A. A corneal abrasion can happen during conscious (IV) sedation because the blink response is slowed. Your mother probably had her eyes open, and something might have brushed against one eye. Since she was sedated, she probably won't remember it happening.

If she keeps using the medication, patches the eye, and takes it easy for a bit, she should improve. For the pain, it may help to put a warm compress over the closed eye.





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Title Post: How does it feel when you have surgery with a retinal detachment?
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