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Sunday, March 9, 2014
Is Sedation Required For Hand Surgery?
I have had several surgical procedures on my left hand and elbow using a Bier Block, which was an awesome technique, first at one hospital with just the block (lidocaine) then at another hospital where they insisted on "conscious sedation" in addition to the Bier Block, which I declined because of a previous negative experience (I found it creepy, significant memory loss with midazolam and with propofol, and it made the surgical experience quite intolerable, which I guess was the opposite effect that anesthesia wanted to achieve)... I`m not trying to dictate my care, but I think that I have a better idea as to what has worked in the past and what does not. Conscious sedation is certianly a bad idea for me; the surgeon does not care. I met with the anesthesia provider (a nurse and about 30 seconds with the MD) and they told me that sedation was "required".... Any ideas as to how to proceed? Its impossible for the anesthesia nurse to take a meaningful history minutes before surgery, and nobody from anesthesia is available for consultation beforehand. This is a university hospital where I teach. Thanks.
I sympathise with your view. As a general rule I can see no reason why a Bier block alone (no sedation) would not suffice for upper extremity surgery below the elbow.
However we cannot diagnose or recommend treatment for individuals, and decision-making requires familiarity with your history, physical exam and test results.
I would suggest that you speak with your surgeon about your wishes and ask that he or she facilitate a discussion with the head of the anesthesia division or group. As you indicated, most surgeons do not have a preference either way, however most surgeons would like the reasonable wishes of their patients to be respected by the anesthesia practitioners with whom they work.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University