Healthsifter by mary desmond pinkowish, since 2003

When Surgical Anesthetics Kill

Laura Landro's article in today's Wall Street Journal is a summary of new research about one of the most feared complications of anesthesia, malignant hyperthermia syndrome. Because of a genetic defect, victims of this syndrome experience a rush of calcium into muscle cells when they inhale anesthetic gases. Their body temperatures streak to 108 or higher, and death is common. Quoting:

"Keith Metz, a member of the board of the Ambulatory Surgery Center Association, says that if inhalation anesthetics are being used, the most important questions for patients to ask are whether the center has an attending anesthesiologist and an adequate supply of dantrolene on hand -- and whether staffers know how to use it. Dantrolene can require preparing and administering as many as 36 vials in quick sequence. Dr. Metz, an anesthesiologist at a surgical center in Southfield Hills, Mich., says he has seen a case of malignant hyperthermia only once in his career. Still, he says, "It's the same as saying we are unlikely to have a fire, but it's important to have a fire extinguisher around."

Because inhaled anesthetics that trigger malignant hyperthermia are cheap, effective and easy to use -- including on children -- they are the drugs of choice in many surgeries. Uses range from ear-tube insertions, wisdom-teeth removal and elective cosmetic surgery to even more complex procedures like open-heart surgery. Drugs that trigger malignant hyperthermia include potent inhalation agents like halothane, isoflurane and sevoflurane, and older drugs like ether. Susceptible patients should be sedated instead with intravenous drugs such as propofol, barbiturates and benzodiazapenes, and short-acting narcotics like fentanyl."

Landro also directs readers to the web site of the Malignant Hyperthermia Association of the United States.

Natural Orifice Surgery--The No-Incision Appendectomy or Gall-Bladder Operation

Time magazine features a story on the removal of the appendix or gallbladder via a "natural orifice," meaning the mouth or vagina in the examples they use. The lack of a conventional surgical incision may reduce complications--or lead to others we haven't encountered before. There's apparently less scarring and less pain. But people aren't flocking to these procedures. Quoting one of the surgeons in the Time article:

"...many patients still have qualms about such procedures. "Speaking with my wife," says Talamani, "the concept of operating through the vagina, was, well, quite foreign to her. That would be a kind way to put it." Dr. Marc Bessler, director of laparoscopic surgery at New York-Presbyterian Hospital, who is conducting a study on transvaginal gallbladder removal, says knee-jerk discomfort with the idea may be keeping patients away. "I was hoping after doing the first few that patients would come looking for this," he says, but they have been slow to arrive. Bessler has thus far removed three patients' gallbladders, but is aiming for 100."

More about natural-orifice surgery here. Healthsifter posted about this several weeks ago.

Cosmetic Surgery: Victim of the Lame Economy

As reported by William Saletan in Slate, doctors who perform cosmetic surgery procedures are feeling the economic pinch. People who used to think of Botox injections as routine maintenance are deciding otherwise as they tighten their belts in this economy. This article quotes a breast surgeon who says that breast augmentation (boob job) business is off by as much as 40% for his colleagues.

Kidneys for Transplant--and for Sale?

Check out this substantial video piece by Drew Carey on the Wall Street Journal Web.ReasonTV website about the case for paid kidney donations and the plight of people who die waiting for transplants.
More information for kidney donors from the University of Maryland.

See an article in MathTrek/ScienceNews about the math involved in matching compatible donors and recipients. More information at the National Kidney Foundation.

How big a problem is the typical delay in getting a kidney? The average wait for a kidney today is 5 years. But according to the information presented in the video, the wait time is expected to double by 2010, just 2 years from now.

"Old" Blood is Risky for Transfusions

Blood for transfusion that has been stored for more than 14 days is linked to more surgical complications than blood stored for 14 days or less. That's the conclusion of researchers at the Cleveland Clinic, who looked at outcomes in more than 2800 patients who had cardiac bypass grafting and/or heart valve surgery between 1998 and 2006. Writing in this week's New England Journal of Medicine, the researchers said that patients who got transfusions of older blood during surgery were significantly more likely than those who got newer blood to die in the hospital after surgery, need more than 72 hours of intubation, experience kidney failure, or develop sepsis or septicemia. Blood for transfusions is already in short supply, so this is unwelcome news. A tough problem.

Articles also in the LATimes and Washington Post.

Appendectomy by Mouth

This IS new: The first oral appendectomy has been performed in the United States, at UC-San Diego. The surgery, which was conducted by a technique called Natural Orifice Translumenal Endoscopic Surgery (NOTES), requires no abdominal incisions except for a small one near the navel where a camera is inserted. The instruments are passed through the mouth and into the stomach, where the surgeons make a small incision so that they can short-cut the intestines and get direct access to the appendix. Patients who get this type of surgery may have a speedier recovery, less pain, and lower risks of hernia and possibly infection. In this unusual press release, the actual patient is identified and interviewed about the after effects. During the past few months, there have been reports of a kidney removed via a small incision at the navel at UT Southwestern Medical Center in Dallas and the transvaginal removal of a gall bladder, also at UC-San Diego. Collectively, these are called minimally invasive surgical procedures.