Health: These patients want to remain conscious during surgery

In 2013 when Dr Anil Bhoraskar a Mumbaibased diabetologist had to undergo a knee replacement surgery general anaesthesia was ruled out since his obesity and other prevailing medical conditions posed a risk The joint was distorted severely Since the knee surgery couldnt be delayed any further I decided to undergo a surgery with minimum risk to life The safest anaesthesia was spinal or epidural Because of the obesity epidural too would carry certain risks so we settled for spinal he saysWhat Dr Bhoraskar also chose to do was remain awake ie in a full state of consciousness during the surgery Since the pain was considerably blunted I was aware of whats going on in the operating theatre I was in touch with the doctors and gave them instructions on how to control my diabetes when to give saline or insulin There was a level of satisfaction since there was no room for goofup he addsBesides the inconvenience of general anesthesia was weeded out The senior doctor was fit enough in two hours postop to be present for a Skype conference with someone in BrusselsLast week The New York Times reported that an increasing number of patients mdash for reasons ranging from curiosity to fear of general anaesthesia mdash were choosing to remain conscious during surgery While the numbers arent yet close to a trend in India there are those who choose to undergo surgical procedures with their eyes and ears open And surprisingly they havent mdash at least not the ones we spoke to mdash been wheeled out traumatisedStaying wide awakeGeneral anaesthesia produces a druginduced state where the patient will not respond to any stimuli including pain Local anaesthesia on the other hand involves the injection of local anaesthetic near the surgical site and is usually used for minor surgeriesRegional anaesthesia includes nerve blocks and spinal blocks This is when local anaesthetic is injected in the vicinity of major nerve bundles that supply body to areas such as the thigh ankle forearm hand or shoulderProcedural sedation is used for procedures where general anaesthesia is not required It allows patients to tolerate procedures that may otherwise be uncomfortable or painfulConscious sedation is a medicationinduced state that reduces the patients level of consciousness A sedated patient does not feel pain but can respond to verbal commands or touchSanjay UpadhyeDr Sanjay Upadhye chief of anesthology and critical care at Asia Cancer Institute and consultant at Breach Candy and Raheja Fortis hospitals says with local anesthesia the harmful effects of general anesthesia are avoidedI saw my leg danglingLengdon Phukan is a 29yearold visual designer with a city firm Having suffered severe rheumatoid arthritis he underwent knee surgery at Vile Parles Dr Balabhai Nanavati Hospital where he was operated on by Dr Pradeep Bhosale director of the joint and knee replacement department Phukans knees says Dr Bhosale were severely damagedMost knee replacement surgeries these days are conducted under regional anesthesia or with a nerve block administered to the femoral nerve mdash a nerve in the thigh that leads to sensation on the upper thigh and inner leg The procedure takes about oneandhalf hours And Phukan was awake all through While he wasnt told that he had the option of taking sedation he does say that there was a doctor who was communicating with him casually making jokes A screen was put blocking Phukans view of his lower limbs I did see my leg dangling weirdly But at no point did I feel frazzled he addsSheela Shinde 65 who got underwent a knee replacement surgery last week without sedation at Vile Parlersquos Nanavati Hospital While Shinde didnrsquot opt for an awake surgery she said aside from a slight pull at the skin below the abdomen she didnrsquot feel anything PicNIMESH DAVESheela Shinde a Kandivli West resident who was discharged last week after a surgery on both knees recalls asking for Dr Bhosale in the OT When he said hello I told him that his presence made me feel better There for four hours I initially shut my eyes as I didnt want a view of the operating theatre adds the 65yearold But she doesnt recall any sensation from the room aside from the skin below her abdomen being pulledDoctors on alertDr Upadhye says patients staying awake during surgery means doctors need to keep a check on how they react Loose talk needs to be avoided You cant for instance shout Give me a sharper knife or tell the assistant you are not holding the retractor properly where did you get your degree This unnerves the patient When a patient is asleep this kind of talk is routine Now the whole team must be conscious of the fact the patient can hear what you say he addsDr Roy Patankar director of surgery at Chemburs Zen Hospital recalls a case in Hong Kong in which a patient who underwent a surgery while awake suffered a perforation of the intestine mdash a technical complication He sued the hospital saying that the operating surgeon at the time of the procedure was on a call with his share broker The patient even pulled out call records which proved him right He won the lawsuit Patankar addsCounseling the patient a day before the surgery and making them understand the pros and cons is also part for the course says Dr Vivek Jawali chief cardiothoracic and vascular surgeon and chairman of the department of cardio vascular sciences and chairman of the Medical Advisory Council of Fortis Hospitals Dr Jawali has been conducting awake surgeries since 1999 taking their number to over 1000 Mostly its foreigners who approach him for surgery without sedation Most Indians are scared of staying awake In Mumbai its only four per cent he says adding that during such procedures patients are given headphones with music to ensure they dont hear any external noise like for instance the whirring of machines He adds that he also got a stray mention on Shonda Rhimes show Greys Anatomy when dogged with how to conduct a complicated heart surgery the team decided to ask him for tips They didnt mention my name but a lot of friends called to inform me he laughs