Pumphead - Brain Monitor - anesthesia

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ken

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http://www.decisivemagazine.com/hea...ients-should-request-brain-monitor-anesthesia

Anesthesiologist Warns of Fatal Dangers Of Going Under

Dr. Barry Friedberg is on a crusade, and it has cost him dearly.

“A lot of people wake up from surgery not quite the same person they were before they went under because of the overuse of anesthetic drugs,” said Dr. Friedberg, a board certified anesthesiologist who has been quoted in numerous medical journals and anesthesia textbooks . He has formed a not-for-profit foundation, called the Goldilocks Anesthesia Foundation specifically to ask patients to request their anesthesiologists use a brain monitor during surgery.
“When we watch a TV show like House or walk through a hospital, we just see a bunch of equipment and monitors, so most people figure that something as logical as a brain monitor would be in use when doctors use general anesthesia. But they aren’t in widespread use at all, and many patients don’t realize they can ask their anesthesiologist to use one. And they should if they want to stay alive and healthy.”

According to the U.S. Department of Health and Human Services, an estimated 53.3 million surgical and nonsurgical procedures are performed during 34.7 million ambulatory surgery visits each year.

“That’s a lot of surgery, and a lot of people being put under general anesthesia without knowing all the risks,” Dr. Friedberg said. “Without a brain monitor, anesthesiology is not an exact science. So most doctors figure it is better to give the patient more than they need in order to make sure they don’t wake up during the operation. Of course, no one in the healthcare food chain is opposed to using more drugs, as that is a large part of the revenue stream.
With a brain monitor, each patient becomes an open book test instead of a mystery to be solved. Doctors would be able to use a more exact dosage, use less drugs and be safer. Instead of using too little or too much, they’d use a dosage that is just right, hence my reference to Goldilocks with my foundation.”

The risks of being over-anesthetized are many, including long term dementia, memory loss and even death, according to Dr. Friedberg. He added that not enough research has truly been done on anesthesia overdosing, because without widespread use of brain monitors during surgery, there is no way to really pinpoint whether anesthesia is statistically a culprit. That’s why Dr. Friedberg urges all patients to ask if their anesthesiologist uses a brain monitor at the time the surgery is scheduled, and to ask for a different anesthesiologist if the one assigned to them doesn’t use one.

Dr. Friedberg‘s message seems simple and prudent enough, but it has not been adopted by his profession, nor by the healthcare industry, because the major players don’t make much money from its use.

“Some hospitals don’t even have billing codes for the use of a brain monitor, and the pharmaceutical companies sponsoring all the junkets for doctors aren’t fond of them, because they invariably result in the use of lower dosages of the drugs they sell,” Dr. Friedberg added. “I don’t make any money from trying to spread this message. I don’t have a secret deal with the monitor manufacturers and I don’t have an axe to grind with the drug companies. In fact, my crusade has cost me professional relationships as well as money out of my own pocket to promote it. I am just tired of the primary task of my profession being not to kill patients. Instead, we should focus on caring for the patients, and understanding the long term risks of overmedicating patients while in surgery. We should be using every tool available to keep them healthy and reduce unnecessary risks through the entire treatment process.”
 

normofthenorth

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Somebody just posted a link to a Duke University page that showed remarkably high rates of cognitive or memory impairment following major surgery, including OHS -- including years later.
 

d333gs

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I am just hearing about this . I have had two surgeries repairing torn up shoulders and had no problem with my state of mind after waking up.but I am going in for a new aortic valve . Is there a difference in the type of anesthesia used ? Does the length of being under correlate with post-op problems?
 

pellicle

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Hi
....but I am going in for a new aortic valve . Is there a difference in the type of anesthesia used ?

essentially no, but they didn't disconnect your heart and stop it during the shoulder surgery did they? The name "Pump Head" refers to the heart lung bypass


Does the length of being under correlate with post-op problems?

statistically IIRC it does.

I found nothing of this on my previous 2 surgeries, but after my 3rd I could say I was confused by some complex things and it took effort to regain it. As I do software development being able to think was critical to my job (although some people would disagree ;-).

There are a litany of reasons to not plan "to do this again". Nobody does better on repeat surgeries than if they'd never needed the repeat. Nobody generally understands or grasps the problems associated with repeat surgeries (and death isn't the big problem, being dead is pretty easy). Scar tissue making surgery harder (possibility of injury due to that may lead to need for pacemakers), increased possibility of infections, surgical left overs.

All this to avoid a pill when the majority of the issues about taking the pill are exaggerated and misunderstood.
 

d333gs

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Thanks guys, I am by no means dismissing this, I have been researching it and decided to see what this forum had to say about it. It is rather alarming. Thinking back I was actually but under way back in 1969 to repair a hand injury. Waking up from that was horrible, vomiting and hallucinations. But the type of Anesthesia has changed i guess because my 2010 experience was more like just waking up, all be it in pain. "Pump head" .......yeah!
 

d333gs

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So, who out there has had post-op cognitive issues ?
Is there a way to take a survey?
I go in on the 23rd for tests and they said to be prepared to stay.
 

almost_hectic

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Ive been put "under" several times for different surgeries over the years. Is there is a cumulative effect from anesthesia?... maybe?... don't know. I do know my short term memory isn't what it used to be, I might think its from being on bypass for valve replacement surgery. Obviously I can't say with any certainty. I do wish my memory was better though.
 

KatherineA

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I know I was completely delusional for at least 3 days after the valve surgery. And an episode of severe anxiety depression after for several months. I’m prone to anxiety depression. However I had successfully managed it without medication for 10 years prior to surgery with meditation, yoga, and other non drug therapies. Surgery the necessary surgical machines, the fentanyl based anesthesia, or the metoprolol Beta blocker messed me up.

It will be two years January 2022. The physical part of surgery and recovery was a breeze. The mental recovery was tough
 

d333gs

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A H , how are you dealing with the STM loss? Are you noticing the memory loss or are people telling you?
 

d333gs

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Ha, SA again;
Heart-Lung Machine May Not Be the Culprit in Post-Op "Pump Head" Syndrome

 

tom in MO

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I am just hearing about this . I have had two surgeries repairing torn up shoulders and had no problem with my state of mind after waking up.but I am going in for a new aortic valve . Is there a difference in the type of anesthesia used ? Does the length of being under correlate with post-op problems?

There is a big difference in the anesthesia used, it's a real cocktail to keep you under for several hours or more. But it's not just the anesthesia but the stopping of your heart and lungs too and the subsequent mechanical blood flow and breathing. There is no "cause" identified. Pumphead is no where near as bad as the alternative of being dead of valve failure. Take heart, most people have no problem and all but 2% of us live :)

I got over most of my symptoms within a few months. For older patients one cannot discriminate between loss of cognitive ability from the pumps or from just other comorbidities that come with age.
 

KatherineA

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I don’t know @tom in MO. Even before I saw earlier article on pumphead and heart lung machine, over this past year plus several months, I have thought a lot about what I would do when this biological valve fails. I’ve thought about it a lot, because I cannot do so many mental tasks yet as well as I could. Mainly legal research and writing on the side since retiring from attorney work 9 to 5.

say this biological valve lasts its 12 year average. I’m not sure I’d have surgery again at say 82. Risk more cognitive damage from anesthesia, the machine, or whatever they want to blame for the cognitive losses.for what? To be in a nursing home sooner? No thanks

Before all the mechanical valve is the only way to go people jump on. I have a Biological valve because I have macular degeneration and warfarin is not recommended. I could be mechanical valve person and blind or biological valve and hope it lasts as long as the rest of this body does
 

d333gs

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Hi


essentially no, but they didn't disconnect your heart and stop it during the shoulder surgery did they? The name "Pump Head" refers to the heart lung bypass




statistically IIRC it does.

I found nothing of this on my previous 2 surgeries, but after my 3rd I could say I was confused by some complex things and it took effort to regain it. As I do software development being able to think was critical to my job (although some people would disagree ;-).

There are a litany of reasons to not plan "to do this again". Nobody does better on repeat surgeries than if they'd never needed the repeat. Nobody generally understands or grasps the problems associated with repeat surgeries (and death isn't the big problem, being dead is pretty easy). Scar tissue making surgery harder (possibility of injury due to that may lead to need for pacemakers), increased possibility of infections, surgical left overs.

All this to avoid a pill when the majority of the issues about taking the pill are exaggerated and misunderstood.
Hi P
I am in the process of learning some basic C++ coding, I hope I don't forget what I have learned over the past year..........
 

pellicle

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I am in the process of learning some basic C++ coding, I hope I don't forget what I have learned over the past year..........
LOL ... you won't forget, but just sometimes the ways to implement complex data structures, or hold in your head a complex E-R diagram, or database table design is a bit misty sometimes.

I just kept working at it, relied more on diagrams on my office wall and kept on plugging.

I guess it helps having done that for like 20 years before.

You'll be fine :)
 

pellicle

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Before all the mechanical valve is the only way to go people jump on.

personally I have never seen that on this site. I've seen robust discussion on which is perhaps better suited to a person who is deciding, but I've never seen an "I told you so" post here.

Decisions are complex and people don't always fully share all details. For my own part I discuss in more generalised "statistical" terms.

Best Wishes
 

pellicle

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Also @KatherineA , I am no expert on macular degeneration but having done a little reading on the subject just now I feel that there may be some misinformation occuring in this area, given that you know your facing (eventually) a redo I would suggest you make it your business to get to the bottom of many "facts". For instance I was reading this site (as a initial starter):

For example:
Fortunately, very few prescription drugs have any known detrimental effects for people with AMD. Warfarin (Coumadin®), which is an anticoagulant blood thinner, is one exception. Doctors often put patients with certain potentially life-threatening cardiovascular conditions on this blood thinner. Studies have shown that patients with wet AMD, which causes bleeding from abnormal blood vessels in the macula, may have larger amounts of blood entering a space under the retina (subretinal hemorrhages) if they take warfarin. This can lead to more severe vision loss. Warfarin does not increase the risk of vision loss in patients with dry AMD.

I've highlighted some significant points, like "may have" and "can lead" as well as the type of MD you have

then found a few points which are not actually correct about vitamin K (green leafy vegetables) and INR ... indeed they seem to be almost "quaint" in their understanding. :

Another issue in patients taking warfarin is that green leafy vegetables can decrease the drug’s anti-clotting effects by providing vitamin K. Some patients on warfarin will be told not to eat leafy greens because this makes it harder to regulate the warfarin dose. Yet, eating these same leafy greens has been shown to decrease the risk of vision loss from AMD.

This advice is now not what is advised, and actually we now are being told to eat as much as we desire to stabilize INR. Futher as many members here will attest "eat your greens" and "dose the diet".

... the article then goes on (in that very paragraph) to say:
The best solution for many patients is to eat a consistent amount of leafy greens each day and have a blood test for warfarin regularly. The test is called an INR (international normalized ratio) and it determines how well warfarin is working by evaluating blood clotting time.

I hope they are dumbing it down for the readers (and not showing how flimsy a grasp they have on the topic).

You've raised yourself points about redo operations and the likelyhood of the increased difficulties in age, so now that you have tried one way, and it was a good "low hanging fruit" decision to go with tissue prosthesis.

I believe its reasonable to do due diligence to see if the situation YOU have is amenable to Warfarin as ACT or not, so that when the time comes (and as I mentioned earlier it may be some years) you are properly informed.

If you find (for instance) that you are not at actually significantly greater risk with your MD then you could participate in some of the discussions here about managing warfarin and minimising your risks there.

That's why we're here.

Best Wishes
 
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