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Q: Medical: Spinal Block vs General Anethesia ( Answered,   0 Comments )
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Subject: Medical: Spinal Block vs General Anethesia
Category: Health > Medicine
Asked by: shopgirl-ga
List Price: $15.00
Posted: 12 May 2002 00:59 PDT
Expires: 19 May 2002 00:59 PDT
Question ID: 15308
This is a medical question.  I have had three major abdominal
surgeries.  I am scheduled for the 4th (and last, yea!!!) on May 24. 
On May 14th I will be visiting with the anesthesiologist.  I want to
have a spinal block (or whatever it is, where you are awake during the
surgery) instead of general anethesia.  I suppose you need the whole
history - so I'll try and crop it down to the essentials:  #1  May 22,
2001 I had bariatric surgery (my stomach was made very small and my
intestines rerouted to cause malabsortion).  This surgery is for the
morbidly obese and it causes significant weight loss. I bled
post-operatively and my crit was down to 19 by the time they got me
back on the table and opened me up again.  (surgery #2) -- About a
week later, I was at a high-level regional hospital for emergent
surgery for an infection.  To correct the problem I was again taken to
surgery.  They took some of the facia and muscle tissue as they
cleaned out the infection.  The wound was left open to heal. (surgery
#3)  This was successful.  Now I have an ungodly hernia (we call it
the alien birth) that is acentuated because of my significant weight
loss.  When you loose a lot of weight you end up with quite a bit of
spare skin *grin*.  And I have, what I lovingly refere to, as a
kangaroo pouch. (extra tummy skin).  This surgery is to repair the
hernia (poke everything back down where it belongs).  Then they are
going to remove that excess skin and cover the amazing scar I now
sport around.  So I will be svelt and beautiful!  And, while I can
joke and poke fun, the truth is I'm terrified of loosing
consciousness.  Both of my children were born c-section and I was
awake.  The surgeon said it "wasn't out of the question" to have a
spinal block, but that I had to speak to the anethesiologists.  I have
heard they don't "like" to do them because they are harder or run the
risk of somehow embarassing the doc if they aren't done just right or
some such thing.  What I would like is any information that is
relevant when comparing these two different types of anethesia. 
Obviously, I would like it to support my position, but if it's a bad
idea, I want to know that too.  I'd like to be well armed with
information and documentation for the 14th.  Thank all you great
google answers!
Answer  
Subject: Re: Medical: Spinal Block vs General Anethesia
Answered By: ephraim-ga on 12 May 2002 10:27 PDT
 
Shopgirl,

You've asked for information about "general" and "spinal" anesthetics.
In an attempt to be complete, I've also included information about
"epidural" anesthetics. Since I am not a doctor, I do not know whether
or not you are a candidate for epidural anesthesia, but you may want
to discuss this with your doctor. Many of these pages also discuss
regional and local anesthesia vs. general.

Note that at the very bottom of my answer, you'll find links to the
NIH site which provides some multimedia tutorials about different
types of anesthesia.

I'll say upfront that it's a good thing you've decided to go into your
surgery while trying to be fully informed. You should most certainly
read everything you can on potential procedures before speaking with
your doctor. I will say, however, that your final decision should be
based on a conversation with a doctor that you trust and *not* only on
the information you find below. If, after reading this information,
you have doubts about your doctor, please go for a second opinion with
a different doctor.

A few years back, I was a candidate for minor voluntary surgery. I was
given an option between spinal, epidural, and general. Being a very
curious person, I asked if I could watch the procedure while under
spinal or epidural anesthetic. He replied that this was impossible
because I would be face down. I asked if I could read a book. He said
this was impossible as well since I would need to remain completely
still. Based on this and the fact that 1-3% of spinal/epidural
patients get severe headaches from the procedure, I opted for a
general anesthetic. Within a few hours after waking up, I went home.

I probably gave the anesthesiologist a severe case of frustration
simply because of the number of questions I threw at him. Keep in mind
that IT IS YOUR RIGHT AS A PATIENT TO BE AS FULLY INFORMED AS
POSSIBLE. IF A DOCTOR REFUSES TO ANSWER A QUESTION, CONSIDER GOING
ELSEWHERE!!!


One of the pages I've referenced below
(http://health.discovery.com/diseasesandcond/encyclopedia/2948.html)
contains the following warning:

"The American Society of Anesthesiologists recently issued a warning
about the potential side effects and interactions of herbal remedies
with medications used before, during, and after surgery. The group
recommends that a person stop taking all herbs at least two weeks
before planned surgery."

Even though the "checklist" I was given before my own surgery included
permission to drink coffee or tea, the anesthesiologist *insisted*
that I ignore this. He explained that while regular tea would not have
any harmful side effects, some herbal teas contain products that can
increase bleeding during surgery. Therefore, he recommended that I
refrain from drinking anything but water beforehand. If you've had
bleeding complications, you may want to take this warning to heart.

Much more information on this topic can be found here:

http://www.asahq.org/PublicEducation/insidherb.html


On to the relevant material. Keep in mind that I'm only providing
short excerpts. If you want to be fully informed before meeting your
doctor, you should read the pages themselves.


The Redding Anesthesia group has the following set of Frequently Asked
Questions about many types of Anesthesia. They gave a very complete
overview of the issues, so I'm listing them first and providing short
excerpts from the relevant pages. Keep in mind that these are the
pages of a specific clinic, so they mix in their own policies and
opinions together with the general information.


http://www.reddinganesthesia.com/frequent.htm

Links to the individual questions.


Discovery.com contains much useful information on various health
topics.

http://health.discovery.com/diseasesandcond/encyclopedia/2948.html


In the following excerpts, I've sorted information from various sites
by topic.

==========================
GENERAL ANESTHESIA
==========================

http://www.reddinganesthesia.com/general.htm

"Will I wake up ?

The risk of serious life-threatening complications from an anesthetic
varies depending the patients co-existing medical conditions as well
as the type of surgery proposed. Those patients with more serious
medical conditions or undergoing more complicated surgical procedures
would certainly be at higher risk than a completely healthy patient
undergoing a minor procedure."

"What are the side effects of general anesthesia ?

Minor side effects from general anesthesia and surgery are common.
These include nausea, sore throat, headache, muscle aches, or a
generalized "hang-over" type feeling. Fortunately these are most often
not serious and resolve on their own in hours or a few days after
surgery. Rarely these side effects are severe enough to require
specific treatment or possibly further hospitalization."


http://health.discovery.com/diseasesandcond/encyclopedia/2947.html

"What are the potential complications after the procedure? [General
Anesthesia]

The most feared complication of general anesthesia is death. This
occurs in roughly 1 out of every 10,000 people. It is not possible to
predict who will have this type of severe reaction.

The medications used in general anesthesia can cause severe reactions.
These include:  liver damage  kidney damage   seizures   low blood
pressure   allergic reactions

Nausea is fairly common for a few hours after the procedure. Other
side effects may occur, depending on the medication used.

[...]

Other complications are possible, such as damage to the mouth or
throat from the breathing tube. The surgery itself may also have
complications."

 
==========================
SPINAL/EPIDURAL/LOCAL ANESTHESIA
==========================

http://www.reddinganesthesia.com/spinal.htm

"What are the risks of Spinal and Epidural anesthesia ?

The risks for Spinal and Epidural anesthesia may include low blood
pressure. Which is the reason the patient is routinely hydrated prior
to the placement of either of these forms of anesthesia. Some of the
time it is necessary to treat it with medication this is regularly by
the anesthesiologist.

Postdural puncture headache occurs infrequently with these techniques.
The risks is 1% with Epidurals and 3% with Spinals. This is believed
to be due to a leak of cerebroSpinal fluid from the needle hole in the
dura. The occurrence of this is greatly reduced by using a smaller
needle when possible. If this headache does occur it may be treated
initially with hydration and pain medicines. If the headache does not
resolve it would be treated with an Epidural blood patch. This if
essentially using the patients own blood to block the leak via the
Epidural technique.

Backache is an infrequent problem. It most likely is due to ligament
strain due to profound muscle relaxation or surgical positioning.

Other complications that can occur include, but are not limited to,
infection, nerve damage(including paralysis, loss of bladder and bowel
function, loss of sexual function), allergic reactions, seizures,
cardiac arrest and death. Although the result of these are severe they
occur very rarely."

"When is a patient not a candidate for a Spinal or Epidural ?

The patient may not be a candidate for these techniques if one is 1)
allergic to certain local anesthetics or narcotics, 2) have disease of
the nervous system, 3) have a bleeding tendency or coagulation
disorder, 4) have an infection of the lower back area, 5) have had
previous lower back surgery, 6) have a Spinal deformity, 7) are
morbidly obese (very overweight), 8) cannot cooperate or get into the
proper position."


http://www.reddinganesthesia.com/local.htm

"What are the advantages ?

Generally speaking, Local and Regional anesthesia are less intrusive
to the body. They tend to affect heart and lung less than the general
anesthesia. As a result, the recovery is faster, the side effects are
less and there is less likelihood of severe heart or lung problems.
Also, these type of anesthesia can provide prolonged pain relief."

"Will I be awake during my surgery or asleep?

You may remain awake or you may be given a sedative to help you relax
and reduce anxiety. This will be different from "general anesthesia"
where you are made totally unconscious and have no awareness or other
sensations. With general anesthesia, your entire body is made to fall
asleep. The idea with local or regional anesthesia is to keep you
sleepy enough so that you are comfortable and can tolerate the
procedure while still breathing on your own, but not so sleepy that
you lose consciousness and require artificial respiration. If this
level of "conscious sedation" is enough for the length of the surgery,
your post-operative recovery will probably be smoother and more
tolerable. Although many patients have this type of sedation where
they remain conscious throughout the surgery, they may still not
"remember" much from their experience because of the "amnesia"
properties of many of the modern-day sedatives. Therefore, after the
surgery, you may think that you had gone to "sleep" yet really only
received conscious sedation."


http://health.discovery.com/diseasesandcond/encyclopedia/2949.html

"What are the potential complications after the procedure? [Epidural
Anesthesia]

The most feared complication of anesthesia is death. This occurs in
roughly 1 out of every 10,000 people who have epidural anesthesia. It
is not possible to predict who will have this type of severe reaction.

The most common problem after an epidural is a headache. This usually
goes away within 24 hours and often responds to pain medication.
Sometimes another injection in the back is needed to help the pain.
Nausea is also fairly common in the first few hours after the
procedure.

Blood pressure can drop very low during an epidural, but this usually
doesn't cause problems. Allergic reactions, arrhythmias or irregular
heartbeats, and seizures are rare complications of an epidural.
Bleeding and infection can occur at the site of the needle injection.
Other side effects may occur, depending on the medications used."


http://health.discovery.com/diseasesandcond/encyclopedia/2950.html
(Spinal Anesthesia)

"Spinal anesthesia is different from but similar to epidural
anesthesia, also known as an epidural. With an epidural, medication is
also put inside the spinal column. However, with an epidural the
medication is injected just outside the sac that surrounds the spinal
cord. A spinal requires less medicine and works faster than an
epidural. However, a spinal is more likely to cause a headache or low
blood pressure."

The answer to the question about "complications" is almost exactly the
same as the one for "epidural," above.


==========================
OTHER INFORMATION
==========================

Here's some more useful information about different types of
anesthesia.

DrKoop.com has the following page which references an article about
risks in general vs. epidural/spinal anesthesia:

http://www.drkoop.com/news/stories/2000/dec/r/15_surgery.html?ptp=true

I suspect that the article which drkoop.com refers to is this, by the
American College of Physicians:

http://www.acpjc.org/Content/135/1/ISSUE/ACPJC-2001-135-1-001.htm
(Abstract only. You may have to search further for the full article.
Before making any decisions based on this article, I *highly*
recommend discussing it with a qualified medical professional.)

http://www.surgerychannel.com/anesthesia/


The National Institute of Health provides the following multimedia
tutorials which may be of use to you:

http://www.nlm.nih.gov/medlineplus/tutorials/epiduralanesthesia.html

http://www.nlm.nih.gov/medlineplus/tutorials/generalanesthesia.html

They also have the following link to general information on Anesthesia
which
is well worth checking out:

http://www.nlm.nih.gov/medlineplus/anesthesia.html


Summary:

Spinal and Epidural anesthesias may have very slightly less major
complications than general anesthesia. They do, however, have other
side effects such as the potential for long-lasting headaches. They
are also not possible for all types of surgery and all people.

Whether or not your doctor "likes" you to see what he's doing should
have absolutely nothing to do with your final decision, and if you get
"vibes" suggesting this, go elsewhere. The doctor's job is to do
what's right for you and give you the most medically appropriate care.

Also, FYI, I used to know an engineer who was able to watch while a
doctor performed extensive surgery on her knee. She was the type of
person who thought this was "cool."

Search terms used: "spinal" + "epidural" + "general" + "anesthesia"
://www.google.com/search?as_q=spinal+epidural+general+anesthesia&num=100&hl=en&btnG=Google+Search&as_epq=&as_oq=&as_eq=&lr=&as_ft=i&as_filetype=&as_qdr=all&as_occt=any&as_dt=i&as_sitesearch=&safe=images

Please remember to discuss all of this directly with your doctor since
your case may have specific circumstances which these general
information sites may not cover.

I hope this helps!

/ephraim
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