Word: anesthesia
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...that we as doctors are invited to attend. In sharp contrast to the joyful, noise of the usual delivery room, there are also few experiences as dreaded by physicians as a quiet delivery room. Mothers whose conditions are precarious may require emergency C-sections and general anesthesia which renders them mute and requires their family members to stay in the waiting room. The lungs of very premature babies may be too undeveloped to make a cry. Rarely, when the condition of a mother or baby is dire, nurses and doctors may used hushed tones. And occasionally, a baby may look...
...movie knows we can take quite a beating yet be oblivious to pain. This is neural blockade at the highest level - in the brain. But it can happen all the way down to the nerve-ending level. There is a well-known pain gate in the spinal cord; regional anesthesia controls pain by temporarily blocking nerve transmission via chemicals injected around more peripheral nerves. Farther down toward the pain-associated nerve endings we create neural blockade with topical anesthetics (like what the dentist puts on your gum so you don't feel the novocaine needle) or even...
Since each patient's response to anesthesia can be different, as San Francisco's Miller was reminded last summer, the guidelines are intended to ensure that whoever administers the drugs should be able to rescue a patient from one level of sedation deeper than the level intended (see chart). "Our job is flying in bad weather," says Zapol. "A fair number of hearts stop in operating rooms, or people stop breathing. The key thing in training is to make people confident at resuscitation...
...type of sedation a doctor will aim for in a given operation, there are no hard-and-fast rules. In general, operating on the extremities offers more options than operating on the body's core, but the dividing lines between levels of anesthesia can be blurry. Once you get away from major surgery, pain control and sedation are often mixed and matched according to patient preference. Says Dr. Ronald Pearl, chairman of the department of anesthesia at Stanford: "It's not uncommon when we do a spinal anesthetic, say for knee surgery, to ask the patients whether they want...
...choosing to stay awake doesn't mean a patient is free of the risks of anesthesia. "We can get in trouble with a local anesthetic," says Zapol. "We can get in trouble with a spinal anesthetic," which keeps pain signals from getting to the brain but doesn't make the patient sleepy. "We can overdose you in all of those places." Someone, whether it's an anesthesiologist, another physician or a fully trained nurse, has to be ready to deal with that possibility. "Surgeons are experts at kidneys and ureters and coronary arteries and lungs. They're skillful people," Zapol...