Sunday, June 23, 2013

Something To Add: Silent Surgery

this is how I felt when I was asked to do 'silent anesthesia'

P.S. the hair is supposed to go INSIDE the bouffant cap, thank you very much!

Recently I had the opportunity to stretch my open mind and do anesthesia for a member of Scientology.

The forms were intimidating. a three-page letter from an expert on Silent Surgery, and a one-page letter from the patient basically telling me what to do. I did my best to stay quiet and to avoid the specific agents requested. The patient did fantastic! But  just in case you are curious, no, they were not a celebrity in any way. (Even if they were I couldn't tell you ; )  )

So for the Anesthesia Community in General, For the Silent Surgery Education and Advertisement Department of Scientology, and for the Energy Healers out there, let us proceed to 'Something To Add'.

Here is the 'deal': 

engram: a mental image picture which is a recording of time of physical pain and unconsciousness.

Scientologists don't want them.

They want to stay 'conscious' and 'free of pain'.

Reiki Doc Says: 
The concept that everything is 'heard' and 'not remembered' during surgery is correct. The patient 'knows' everything that is going on, but later has no access to those memories. That's why I don't let people talk trash about my patient, as if anyone would in the first place. But I watch for this.

For staying 'conscious' options, I think regional anesthesia is an excellent choice. Lower extremity and some less invasive abdominal procedures are able to be done under spinal, epidural, or regional blocks such as a femoral three-in-one, sciatic, popliteal, or ankle block. Some upper extremity procedures may be done under axillary block, inter scalene, or Bier block. 

The only drawback with regional anesthesia that is not epidural or spinal is that local anesthesia causes seizure when absorbed too rapidly or injected intravascularly. Small doses of benzodiazepine are routinely given to raise the seizure threshold as added safety against seizure in case of inadvertent rapid absorption of local anesthetic.

Scientology also recommends 'bilateral TAP blocks' for abdominal pain post-op. I have never seen one of these done and would have to look one up before I did one. I wouldn't advise that for post-op pain control. Pain pumps (little spring-loaded slow drip drains filled with local anesthesia) are preferred in this and many thoracic cases. 

General Anesthesia

Scientology Says:
NO! Well actually, no:
  • Barbiturate
  • Etomidate
  • Ketamine
  • Benzodiazepines (midazolam, alprazolam, chlordiazepoxide, temazepam)
Again, this is to avoid the engrams.

Otherwise unconsciousness with general anesthetics, propofol, and narcotics is 'okay.

Reiki Doc says:
OK! I'm on it!

Barbiturate--we can't even get Sodium Pentothal for lethal injections by the state. It is no longer made, I believe. This is a non-issue. Years ago, we gave methylhexital for ECT (electroconvulsive therapy) because it gives a better seizure than propofol. Now it's usually propofol.

Etomidate--one dose isn't going to suppress the adrenals much. Those studies were done when etomidate was used for ICU sedation. (plus many elderly are adrenocortically suppressed and have no knowledge they are. I give steroid bolus to all over seventy just in case, it's cheap and preventive.) 
Etomidate is used when the patient is very unstable and might die if given propofol to go to sleep. Typically we use Etomidate for emergencies only. Chances are in an elective setting and good health, it would not be used.  You might want to think about the risk to benefit on etomidate in the situation of emergent, life-saving surgery where a patient is in hemodynamic shock.

Ketamine--This is used in veterinary medicine, too. It is a 'dissociative anesthetic', the patient 'knows' what is going on but 'doesn't care', much in the same way a frontal lobotomy is known to do. There can be terrible hallucinations in adults if no benzodiazepine pre-med is given first. A powerful painkiller, ketamine is used in changing dressings and bathing burn patients who have frequent procedures. It is also often mixed with propofol for long facial plastic surgery procedures under 'MAC'. The only time I would use ketamine clinically is the violent patient that might hurt me (i.m. like a tranquilizer dart), and the dying patient who needs blood pressure to go UP instead of stay level like etomidate on induction. You might want to think about situations where life is at risk and give the okay on ketamine in this instance.

Benzodiazepines--are used to decrease anxiety in surgery, especially pre-op. I can take them or leave them, but in cases of cardiac disease, propofol would frankly kill the patient if I only gave that. I use a large dose of versed and fentanyl to keep blood pressure stable. You might want to re-think risk to benefit on this one for alcoholics (withdrawal in hospital can be fatal), anxiety disorder, and cardiac disease.

On The Healing of Surgery:

Scientology says: 
Surgery is a necessary evil that is full of pain and has to be controlled.

Reiki Doc says:
Surgery is a time for deep healing that is personal for each patient involved. For RELIGIOUS ACCOMMODATION we are pleased to provide what care you request. 

However, surgery can be a time of great joy and service in the healers involved. Many have been called to the healing specialties out of great love for humanity and desire to 'give something back'.  Provided that the patient is sufficiently under general anesthesia, there is little risk of 'pain' being experienced while 'unconscious' so the engram, in my opinion, has little chance to form. The pall and sense of restriction in that room for the length of surgery created feelings that were not 'light' for everyone involved in the procedure. I ask you to question, 'where is the healing when the energy is not favorable to the optimum function of the team at work on the patient in the O.R.?' It's just a thought, whatever you decide is okay with me.

Furthermore, when individuals are trained in energy medicine, vast amounts of healing can be harnessed for the benefit of the patient, no matter what the religion, as health is a divine right and all of humanity is deserving of this gift.

From Me to You:

Thank you for taking me outside my comfort zone. After doing anesthesia for so many years, I had no clue there was any medical 'interaction' with your religion. I consider myself informed and will strive to do whatever possible for the comfort and care of your patients.  It is my hope that my expertise in anesthesia that I shared with you today will help put more of your patients at ease in the future.

After all, Love is the Solution For Everything! 

Do you not agree?

Mahalo and Aloha,

Reiki Doc