What I Need to Know About Surgery and Anesthesia
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1 What I Need to Know About Surgery and Anesthesia Zvi Grunwald, M.D. The James D. Wentzler Professor and Chairman Department of Anesthesiology, Sidney Kimmel Medical college Thomas Jefferson University, Philadelphia, Pennsylvania December Florida,
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3 The First Successful Anesthesia And the Lord God caused a deep sleep to Fall upon Adam, and he slept; and he took one of his ribs, and closed up the flesh instead thereof Genesis, 2, (21)
4 The First Successful Surgical Procedure Anesthesiologist/Surgeon And the Lord God caused a deep sleep to Patient Fall upon Adam, and he slept; and he Thoracotomy took one of his ribs, and closed up the flesh instead thereof; Genesis, 2, (21) Anesthesia Outcome
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6 The First Public Display of Anesthesia October 16, 1846 William Thomas Morton Massachusetts General Hospital in Boston
7 Objectives What I need to know about Anesthesia (FOP Patient) How to prepare for surgery and anesthesia (Physician) What the anesthesiologist should know about FOP (The Anesthesiologist)
8 What I Need To Know About Anesthesia and Surgery Types of anesthesia Nerve blocks Regional anesthesia General anesthesia
9 Local Anesthesia and FOP Injections are not recommended for FOP patients
10 Regional Anesthesia and FOP Injections are not recommended for FOP patients
11 General Anesthesia A reversible state of unconsciousness, produced by anesthetic agents, with Absence of pain sensation over the entire body
12 General Anesthesia and FOP Safe Good track record Excellent for in-patient and ambulatory patients
13 The Challenge There is a need to safely secure the breathing Need to insert a breathing tube to the wind pipe Even if can open the mouth Especially challenging if the mouth is shut close Need an Expert Anesthesiologist
14 The Anesthesiologist will see you at the day of the surgery A 39 years old patient is scheduled for surgery tomorrow, what kind of a gas will she need for anesthesia? She is in the hospital treated with IV antibiotics for bronchitis I am having a colonoscopy tomorrow. The gastroenterologist assured me that the anesthesiologist will see me tomorrow. Not a good advise!!!
15 What the Anesthesiologists Should Know About Me?
16 What the Anesthesiologists Should Know About Me? For Every Patient Your age, weight, height
17 What the Anesthesiologists Should Know About Me? Allergies For Every Patient All your medical problems Special attention: Asthma, Diabetes, heart or breathing problems All your medications (over-the-counter, herbal) Previous surgeries
18 What the Anesthesiologists Should Know About Me? Tell the anesthesiologist that - YOU ARE A PATIENT WITH FOP! He/She needs has to MUST meet with you prior to the day of surgery Educate him/her about the FOP
19 What the Anesthesiologists Should Know About Me? You cannot open the mouth You need special accommodations for mobilization and positioning Your body reacts to needle insertion He needs to assemble a team to care for you
20 Case Reports Describing Anesthetic Management Article Age (Y) Intubation Discharge Complications: anesthetic asleep nasal fiberoptic 2 days difficult to ventilate Surgery submandibular abscess awake fiberoptic nasal not described none D&C mask GA not described none eye eviceration awake fiberoptic nasal several blood loss femur & spine fx's division of ossified awake fiberoptic nasal several none masseter muscles asleep DL 5 days none hysterectomy, BSO awake FOI-->blind nasal several ETT would not pass during FOI Ex lap; pelvic mass brainstem lesion; sedated nasal FOI 7 days none Craniotomy osteomyelitis 5th U/S guided ankle block not described none in 7 days digit right foot fiberoptic nasal intubarion (awake??) 4 days none, but OMF literature dental rehab thoracic oral intubation (awake??) 2 days none noted laminectomy
21 Special Patients Deserve a Special Team Anesthesiology Dentistry Oral Maxillofacial Surgery OB/GYN Otolaryngology GI Urology FOP Patient Cardiology Nursing Intensive Care
22 Keys To Success Multidisciplinary effort Communication ENT OMF JMC Anesthesiology Developed unique techniques to manage care of patients who cannot open their mouth Plans for failed intubation
23 How We Prepare for Your Surgery? Pre-operative evaluation, focused on airway and pulmonary exam Communication Specialists Special arrangements Waiting area Operating rooms Recovery area
24 The Challenge Position (Truncal Rigidity) Ankylosis of vertebral column, shoulders and elbows Confined to wheel chair, semi-erect Injury Susceptibility Any stimulation will lead to bone formation: IV, DL, nerve block
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26 The Challenge Respiratory Compromise Other co-morbidities Diabetes Asthma Congenital heart dis.
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31 Fasting Before Surgery Recommended Dietary Precautions Fasting - Hours Age Milk/Solids Clear 0-5 Mon Mon > 3 Y 8 2-3
32 Pre-induction
33 Aerosolized 4% Lidocaine
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Common Formats Aggregate Report Hospital SURGERY OR ANESTHESIA DEFINITION OF EVENT EVENTS INCLUSIONS Event type Incidents 823 174 257 225 167 Harm 735 154 228 205 148 No harm 88 20 29 20 19 Can t tell
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