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How safe is Anesthesia?

bakemeacookie

bakemeacookie

New member
Hello peoples...

My doofus 70 y/o dad fell off a ladder changing a lightbulb and broke both his hands. One will heal fine with a cast - the other they want to put some steel rod in his wrist. They want to do surgery and two options is anesthesia or freeze the arm.

Clearly I want the freezing option. I've heard many horror stories on anesthesia and he's got a weak heart. Any suggestions?
 
1. What does weak heart mean to you

2. What other medical problems does he have

3. What medications does he regularly take

4. Has he had general anesthesia before
 
chris302001 said:
1. What does weak heart mean to you

2. What other medical problems does he have

3. What medications does he regularly take

4. Has he had general anesthesia before
Click to expand...

1. He had a mild heart attack last year.

2. Just the heart attack scare, healthy other-wise.

3. None that I know of.

4. no.

c
 
also, you'd need a good physical exam and probably an ekg, chest xray, and basic lab work to really assess him. This would all be most likely performed by your dad's pcp.

Why you would ask EF instead of a professional who has a relationship with your dad is beyond me. If your dad has no pcp at 70, then good luck chuck.
 
bakemeacookie said:
1. He had a mild heart attack last year.

2. Just the heart attack scare, healthy other-wise.

3. None that I know of.

4. no.

c
Click to expand...

he had a mild heart attack and is on no meds? He should probably be on Coreg, Lisinopril, (insert your favorite statin), and atleast a baby aspirin.
 
chris302001 said:
also, you'd need a good physical exam and probably an ekg, chest xray, and basic lab work to really assess him. This would all be most likely performed by your dad's pcp.

Why you would ask EF instead of a professional who has a relationship with your dad is beyond me. If your dad has no pcp at 70, then good luck chuck.
Click to expand...

He lives like 3,000 miles away. It's hard to get info from him and other family members. He's on morphine, but they're going to decide type of anesthesia today - if surgery is 2morrow.

c
 
bakemeacookie said:
He lives like 3,000 miles away. It's hard to get info from him and other family members. He's on morphine, but they're going to decide type of anesthesia today - if surgery is 2morrow.

c
Click to expand...

is he an inpatient right now? If so, Cards will swing by and stratify his risk. The surgeon and cardiologist won't send him under general if it is unsafe.
 
chris302001 said:
is he an inpatient right now? If so, Cards will swing by and stratify his risk. The surgeon and cardiologist won't send him under general if it is unsafe.
Click to expand...

No. Hospital in Toronto. I really hope they're pros and not just look at him as some old geezer and "not really care that much".

c
 
I will find out tomorrow. I already told family & dad to demand not going under. I don't if they can actualy overrule a medical decision.

c
 
why are you so against anasthesia? if he needs it he needs it, no ammount of bitching will change that, take a chill pill.

and best wishes to your pops
 
bakemeacookie said:
Hello peoples...

My doofus 70 y/o dad fell off a ladder changing a lightbulb and broke both his hands. One will heal fine with a cast - the other they want to put some steel rod in his wrist. They want to do surgery and two options is anesthesia or freeze the arm.

Clearly I want the freezing option. I've heard many horror stories on anesthesia and he's got a weak heart. Any suggestions?
Click to expand...

Is it a steel rod or a steel plate they want to put in his wrist? It would be unusual to use an intermedullary nail (a.k.a. a "rod") in that location.

The most popular approach for a complicated wrist fracture is a volar distal radius approach. It's a pretty ugly cut-down to get to the bone, but the plate doesn't have to be removed afterward.

1) Is it a distal radius fracture (I'm guessing so)?

2) Is it radius only, or a both-bone fracture?

3) If it is distal radius, is it highly comminuted (lots of little pieces)?

4) Do they have to restore the articular surface (is the joint itself all crunched-up), or are they just concerned about shortening and/or dorsal tilt (where the bone heals, but gets turned upward)?

There is a lot of literature that suggests the use of just plaster or pins and plaster (less invasive treatment) if he isn't going to be using his wrist in high demand.

And finally, if he needs a plate but doesn't want to go under, I'd consider using a block and using a Bekton plate. It's a dorsal approach to the wrist and most modern physicians will laugh at you. While the plate has to be removed about six weeks after the procedure, it isn't nearly as invasive as a volar approach and he can use his hand (just not his wrist) in the meantime (much less swelling and much less rehab necessary).

HTH
 
mrplunkey said:
Is it a steel rod or a steel plate they want to put in his wrist? It would be unusual to use an intermedullary nail (a.k.a. a "rod") in that location.

The most popular approach for a complicated wrist fracture is a volar distal radius approach. It's a pretty ugly cut-down to get to the bone, but the plate doesn't have to be removed afterward.

1) Is it a distal radius fracture (I'm guessing so)?

2) Is it radius only, or a both-bone fracture?

3) If it is distal radius, is it highly comminuted (lots of little pieces)?

4) Do they have to restore the articular surface (is the joint itself all crunched-up), or are they just concerned about shortening and/or dorsal tilt (where the bone heals, but gets turned upward)?

There is a lot of literature that suggests the use of just plaster or pins and plaster (less invasive treatment) if he isn't going to be using his wrist in high demand.

And finally, if he needs a plate but doesn't want to go under, I'd consider using a block and using a Bekton plate. It's a dorsal approach to the wrist and most modern physicians will laugh at you. While the plate has to be removed about six weeks after the procedure, it isn't nearly as invasive as a volar approach and he can use his hand (just not his wrist) in the meantime (much less swelling and much less rehab necessary).

HTH
Click to expand...

First thx. I emailed this to my sister to ask the phy.

Secondly, I'm confused. Are you suggesting the Volar approach or the Bekton approach? You're saying if someone asked for the Bekton approach - it's very archaic and few do it? I don't know if Plaster & Pins is an option.

c
 
bakemeacookie said:
First thx. I emailed this to my sister to ask the phy.

Secondly, I'm confused. Are you suggesting the Volar approach or the Bekton approach? You're saying if someone asked for the Bekton approach - it's very archaic and few do it? I don't know if Plaster & Pins is an option.

c
Click to expand...

The most popular is the volar approach. It puts a plate deep inside the wrist. It's a fairly complex cut-down that most definitely requires the patient to be under. It's very popular (IMO) because 1) It doesn't require a second surgery to remove it and 2) It gives a very precise anatomical reduction (the pieces fit back together more accurately). The precise anatomical reduction sounds great at first, except patients in your father's situation don't always benefit from it. There are plenty of people out there with crooked wrists that still function adequately. And there are also plenty of people out there with well-reduced wrists that are still stiff and don't work well. So unless you are dealing with someone who expects a lot out of their wrist (i.e. athlete), it putting every piece back in place may not be the best choice.

The Bekton plate is a much older technique. The fracture is fixed from the dorsal side (the back of the hand). You can see how little soft tissue you have on the back of your hand -- that's both a good and a bad thing. It's good because the plate can be slipped right under the skin. It's bad because the plate has to be removed later. Doctors don't like it as much because (1) It involves two surgeries and (2) You can't send the patient straight to rehab with this plate. Their wrist is frozen during healing, but then the plate can be popped out under local later.

So if I were you and anesthesia was a concern, I'd consider asking if your dad would be a good fit for a Bekton plate. They may be able to put that in under a local and I know for a fact they can take it out under a local. There are a fair number of fractures this plate can address, but it definitely can't do all fracture types.
 
mrplunkey said:
So if I were you and anesthesia was a concern, I'd consider asking if your dad would be a good fit for a Bekton plate. They may be able to put that in under a local and I know for a fact they can take it out under a local. There are a fair number of fractures this plate can address, but it definitely can't do all fracture types.
Click to expand...

Yeah, the anesthesia is the main issue. I read too many articles about anesthesia deaths, and I don't want my dad to die during the surgery. You know hot it is. I will find out tomorrow form the docs what the say. Sometimes it's hard hearing it from a 3rd person what's going on - but best I can right now.

All things considered, I think the 1 surgery Volar would be ideal. I'd rather doc do a surgery he's pretty familiar with.

c
 
bakemeacookie said:
Yeah, the anesthesia is the main issue. I read too many articles about anesthesia deaths, and I don't want my dad to die during the surgery. You know hot it is. I will find out tomorrow form the docs what the say. Sometimes it's hard hearing it from a 3rd person what's going on - but best I can right now.

All things considered, I think the 1 surgery Volar would be ideal. I'd rather doc do a surgery he's pretty familiar with.

c
Click to expand...

The volar approach would definitely require general anesthesia.

But your point about familiarity is well made. If he's got a volar plate jockey for a surgeon, anything else may very well fry his circuits.
 
I've gone under and it's awesome! 4 hours gone by in what seemed like 3 seconds. Total fuck yeah moment.
 
No anesthesia is without risks, for any age, so that makes it down to the opinion of your Dad, you and the doctors.

Personally, I'm scared to death of general anesthesia. and I've refused it. They can do nerve blocks so your whole arm or leg, whatever, is totally numb, and if you look the other way, you will have no idea they're cutting on you. That's what I'd do, but again, that's a medical and personal decision.

I volunteer for various medical experiments now & then, and last week I had a nerve conduction study done on my right arm (it's some kind of study to compare regeneration of nerve tissue). They gave me an injection in the armpit (sounds bad but wasn't), and my whole arm was numb! And it stayed numb for 2 hours, and they put needles in to key points on my arm with nerve stimulators, which would have given electric shocks if I had not been numb. No big deal, and no pain, no problem. That's what I'd always ask for if I needed even major arm/hand surgery.

I wish your Dad a quick & total recovery!

Charles
 
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