Tuesday, November 20, 2007
Surgery and Anesthesia Risks and Benefits

By Anthony Policastro, M.D

There are many different reasons to have surgery. Surgeons usually explain the risks, benefits and alternatives to surgery. However, there are also risks benefits and alternatives to anesthesia. Sometimes surgery is done under local anesthesia. Sometimes, it is done under general anesthesia. Sometimes, moderate sedation is used. This means the patient is not fully asleep, but also not aware of the procedure. The type of anesthesia used depends on multiple factors. One of those factors is related to how significant the surgery is. Some surgeries are called minimally invasive. They may also be termed low surgical invasiveness. These surgeries include tubal ligation. They include cataract surgery. They include joint arthroscopy. These procedures have very few complications. They have little blood loss. They do not interfere with usual physical functioning of the body. A second group of operations are called moderately invasive. They are also known as medium surgical invasiveness. They include gall bladder removal. They include basic prostate surgery. They have few complications. They rarely require blood replacement. They do have some effect on the physical functioning of the body. The third group of operations is called highly invasive. They are also known as high surgical invasiveness. They include hip replacement. They include open-heart surgery. They include brain surgery. They have a higher rate of complications. They have a greater likelihood of needing blood. They have effects on the physical functioning of the body. So the first consideration in terms of providing anesthesia is how significant is the surgery itself. The second consideration is related to the physical condition of the patient. There are five levels of physical condition that are used. Level 1 patients are those who are normal and healthy. Level 2 are those with only mild acute disease or adequately treated chronic disease. Level 3 are those with moderate disease. Level 4 are those individuals with a disease that could be a threat to life. Level 5 are those individuals who are likely to not survive surgery. Most patients fall into Level 1 or Level 2. They are basically healthy. They are often having elective surgery. They are likely to be having minimally invasive surgery. That means that they do not need a lot of evaluation before their surgery. However, as the invasiveness of the surgery increases, so does the need for a careful evaluation before surgery. As the level of physical condition worsens, so does the need for a careful evaluation before surgery. In a level 4 patient with highly invasive procedure, the patient should expect a very thorough evaluation before surgery. The reasons for this should be obvious. One evaluation before surgery is done by the operating surgeon. That individual may need the help of consultants to make sure the patient is healthy enough for the surgery. The consultants may be cardiologists. They may be pulmonary medicine specialists. They may be of other specialties. A second evaluation before surgery is completed by the anesthesiologist. The more significant the patients underlying condition, the more need there is to do this evaluation before the day of surgery. The more complex the surgical procedure, the more need there is to do this evaluation before the day of surgery. When both complex surgery is planned and the patient is sick, the evaluation is a necessity. A survey of anesthesiologists showed that 96 percent of them felt that a visit before the day of the surgery was necessary in patients with complex surgery and severe underlying disease. 71 percent of the same group felt that a visit before the day of surgery was necessary in patients with low risk procedures but severe underlying disease. 72 percent of them felt that a visit before the day of surgery was necessary in patient with complex surgery but little underlying disease. The bottom line is that if the surgery is highly invasive or if the patient has underlying health problems, they should expect an evaluation by anesthesiology before the day of surgery. The evaluation should concentrate on evaluation of the breathing passages. It should concentrate on evaluation of the lungs. It should concentrate on evaluation of the heart. Other items to be looked at include the list of all the patients chronic problems. Allergies need to be evaluated. A list of current medications should be reviewed. Other things should be evaluated based upon the patients medical history. Other tests may or may not be necessary. Surgical anesthesia is complicated. Patients should make sure they understand that aspect of their surgery beforehand.

State Confirms First Flu Cases
Delawares Division of Public Health (DPH) reports the states first laboratory confirmed cases of influenza for the 2007-2008 flu season. Two children from Kent County, ages 3 and 5, were confirmed with type B influenza on Nov. 13 by the Delaware Public Health Laboratory using a genetic test. Of the 178 lab-confirmed cases of influenza nationwide since Oct. 11, 6.2 percent were influenza B viruses similar to Delawares case. DPH monitors the occurrence of influenza - like illnesses in all hospitals and selected long term care facilities, large businesses and stand alone medical clinics. National reports from Oct. 28 - Nov. 3 indicate a low level of influenza activity across the United States. DPH strongly encourages health care providers to submit specimens from suspected influenza cases to DPHs laboratory for culture confirmation and sub-typing to help with disease surveillance. This service is offered free of charge and test results are reported to participating providers. DPH has also distributed 28,630 doses of flu vaccine to health providers enrolled in the federal Vaccines for Children program. This program supplies vaccine for children enrolled in Medicaid, uninsured children and children with insurance that does not cover vaccines. DPH continues to conduct scheduled flu vaccination clinics statewide and administered 1,945 doses as of Nov. 3. For clinic dates and locations, visit These clinics vaccinate people in the following risk groups:
  • Children age 6-59 months old.
  • Adults 50 years and older.
  • People ages 2-49 with chronic medical conditions.
  • Adults or children with spinal cord injuries, seizure disorders, or other muscle and nerve conditions that lead to breathing and swallowing problems.
  • Women who will be pregnant during flu season. Vaccination can occur in any trimester.
  • Household contacts of out-of-home caregivers of children less than six months old.
  • Residents of long-term care facilities.
  • Healthcare workers involved in direct patient care.
  • Out-of-home caregivers and household contacts of people in the other high-risk categories.

  • Depression Support Group in Laurel
    The Mental health Association in Delaware will be sponsoring a Depression Support Group in Laurel on the second and fourth Thursdays of each month. The meetings begin at 7 p.m. The purpose of the Laurel Depression Support Group is to share experiences related to living and coping with depression. The group is confidential and offered at no charge. The MHA encourages anyone dealing with a depressive disorder to attend. Register by calling 800-287-6423. Peer support groups sponsored by Mental Health Association of Delaware are not intended to replace professional mental health treatment. To maintain the privacy of our members, MHA does not publish support group locations; locations are provided with registration.

    Stroke Support Group
    Nanticoke Memorial Hospital will offer free monthly Stroke Support Group meetings designed for individuals who have survived a stroke and their families and caregivers. Meetings are held the third Thursday of each month at Nanticoke Cancer Care Center, from 1:30 - 3:30 p.m. The meetings will consist of guest speakers and breakaway sessions, in which caregivers and survivors will meet in two groups to discuss concerns, provide support and networking. Refreshments will be provided. Sheila Brant and Joan Burditt, occupational therapists at Nanticoke Memorial Hospital, will facilitate the support group meetings. Pre-registration is not required. For more information, call 629-6611, ext. 5121.