Waking up during surgery
When undergoing surgery, a patient is usually put to sleep using anesthesia. But that is not the only drug given to them. In order to insert a tube down a patient’s throat to ventilate them, and in order to cut through muscle, the patient’s muscles have to be paralyzed. A drug that causes that is given prior to surgery. When the anesthesia doesn’t work, for any reason, the patient is left with the paralyzing drugs working – meaning they can’t move, speak, blink the eyes or otherwise respond to the pain, if they feel it.
So when does anesthesia not work? There can be a number of reasons:
Not using the full dose of anesthesia – In some high-risk surgeries, such as trauma, cardiac surgery, emergency c-sections, or when the patient’s condition is unstable, using the usual dose of anesthetic could harm the patient. In these situations awareness may not be completely avoidable.
Patient physiology – Some people may be more resistant to anesthetics than others. This can happen due to a genetic condition. Other things, such as other drugs, may interfere with the action of the anesthetic drug and may require using a higher dose of it in order for it to work effectively.
Human error – Sometimes a drug dose which is too low may be the cause. Also inadequate monitoring during surgery may be the cause, when there is a need for an increase in drug dosage, but no one has noticed.
How does it feel?
Most people don’t feel the pain of surgery. But even without pain, the experience can be traumatic. The patient can recall the details of their own surgery. Some describe it as being trapped inside a corpse.
Freud and cocaine
As a medical researcher, Freud was an early user and proponent of cocaine as a stimulant as well as analgesic. He believed that cocaine was a cure for many mental and physical problems, and in his 1884 paper “On Coca” he extolled its virtues. Between 1883 and 1887 he wrote several articles recommending medical applications, including its use as an antidepressant. He narrowly missed out on obtaining scientific priority for discovering its anesthetic properties of which he was aware but had mentioned only in passing. (Karl Koller, a colleague of Freud’s in Vienna, received that distinction in 1884 after reporting to a medical society the ways cocaine could be used in delicate eye surgery.) Freud also recommended cocaine as a cure for morphine addiction. He had introduced cocaine to his friend Ernst von Fleischl-Marxow who had become addicted to morphine taken to relieve years of excruciating nerve pain resulting from an infection acquired while performing an autopsy. However, his claim that Fleischl-Marxow was cured of his addiction was premature, though he never acknowledged he had been at fault. Fleischl-Marxow developed an acute case of “cocaine psychosis”, and soon returned to using morphine, dying a few years later after more suffering from intolerable pain.
The application as an anesthetic turned out to be one of the few safe uses of cocaine, and as reports of addiction and overdose began to filter in from many places in the world, Freud’s medical reputation became somewhat tarnished.
After the “Cocaine Episode” Freud ceased to publicly recommend use of the drug, but continued to take it himself occasionally for depression, migraine and nasal inflammation during the early 1890s, before giving it up in 1896. In this period he came under the influence of his friend and confidant Fliess, who recommended cocaine for the treatment of the so-called “nasal reflex neurosis”. Fliess, who operated on the noses of several of his own patients, also performed operations on Freud and on one of Freud’s patients whom he believed to be suffering from the disorder, Emma Eckstein. However, the surgery proved disastrous.
Some critics have suggested that much of Freud’s early psychoanalytical theory was a by-product of his cocaine use.
Compartment syndrome occurs when swelling due to injury (muscle repair metabolism) occludes nerves and vessels and causes a dangerous rise in pressure that spurs ischemia and tissue damage.
The first heart-lung transplant
Bruce Reitz, MD, (left) and Shumway perform the world’s first successful combined heart-lung transplant on March 9, 1981. In the four-hour operation, the heart and lungs of an anonymous donor were implanted in the chest of Mary Gohlke, a 45-year-old newspaper executive from Mesa, Ariz.
Aortic Valve Surgery
The aortic valve is located between the left ventricle (lower heart chamber) and the aorta, which is the largest artery in the body. Valves maintain one-way blood flow through the heart.
During aortic valve surgery, the aortic valve may be repaired or replaced. The results of your diagnostic tests, the structure of your heart, your age, the presence of other medical conditions and other factors will be considered to determine whether aortic valve repair or replacement is the best treatment approach for you.
During traditional aortic valve surgery, a surgeon makes a 6- to 8-inch incision down the center of your sternum, and part or all of the sternum (breastbone) is divided to provide direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves. However, today a lot of these surgeries are done minimally invasively.
Spinal surgery. Close-up of an exposed spinal cord (centre) with screws on either side. Metal retractors are used to hold back the patient’s skin and flesh, providing the surgeons with access to the spine.
