Thursday, August 10, 2006

Twilight sleep requires an expert

…Always sounds so benign…twilight sleep. Some form of painkilling drowsiness that isn’t as dangerous as real anesthesia. Lullaby and good night.

…All HA had to hear was that it merely made you forget the pain, didn’t stop it. Whether that is strictly true or not, she is now death, death!, on these semi-asleep options.

…Writing in the Wall Street Journal (Aug 9, 2006), Laura Landro says med professionals themselves are getting concerned about this type of anesthesia, which is apparently quite cost-saving in that you don’t need to pay a medical doctor to administer it—and you pop awake and can go home without occupying an expensive hospital bed.

…Nearly 70% of surgeries are now “out patient,” which HA pronounces
OUT, PATIENT!, even though she knows staying in the hospital is also dangerous.

…Many use this sedation involving versed and fentanyl for colonoscopies, dental procedures, and other out-patient procedures.

…Problems—there were 1,690 so-called “incidents” last year—range from overdoses to starting before the patient is “under.”

…Sometimes nurses are allowed to administer these drugs (some insurance cos won’t pay for an anesthesiologist).

…Hospitals are setting up certification programs, with refreshers every couple of years.

…People, say the experts, should be prepared to deal with someone one level below the twilight level. Weight, age, and use of other drugs can govern how deeply people go.

…There are rescue drugs (for versed and fentanyl, anyway). These should always be on hand.

…You need to ask: Who will be handling your sedation? How many cases have they handled?

…What equipment is in the room in the case of an overdose?

…Are you safer in a hospital? No, Lauro reports. Not necessarily. Only half of providers allowed to administer sedation are schooled in airway management.

…The time to look out for yourself, clearly, is while you are still awake.

…You don’t want to turn Twilight Sleep into Twilight Zone.


Bill Thomasson said...

I don't understand what is said about general anesthesia and staying in the hospital. I had my hernia operation in the afternoon, under general anesthesia, and was home by 5.

And I had my dolonoscopy without any sedation at all. Although others disagree, as far as I'm concerned dealing with the moderate discomfort is less of a problem than dealing with the after-effects of sedation. I was able to walk home, which I couldn't have after sedation.

Star said...

Some people do get "out patient"
with general anesthesia. What was meant was that some people also think a hospital will be better equipped for anesthesia or this sedation stuff and that is not always the case.

Of course, if it goes wrong, intensive care is right there...

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