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From: "Howard McCollister" <>
Subject: Re: Laparoscopic Surgeryy
Date: 19 Jan 2005 06:51:02 -0600
Message-ID: <41ee572c$0$5362$>

"REP" <> wrote in message

> Interesting. Thanks. I was only really aware of the importance of not
> vomiting while under anesthesia.

The danger isn't vomiting under general anesthesia, it's vomiting under
*induction* of general anesthesia. When the patient is under, there is an
endotracheal tube with a balloon on it in the trachea, which prevents
aspiration of any vomitus into the airway. It's getting to that situation
that is worrisome since there is a transition period as the patient is going
under (being "induced") where there is no tube protecting the airway, but
they're deep enough that their reflexes are gone and they can't protect
their own airway. It's that 15 second period of time that worries
anesthetists, since vomiting/aspiration is the most common dangerous
anesthetic complication these days. In reality, it is quite rare
in fact that it has led some anesthesiologists to suggest that the concept
of fasting for 8 hours before surgery is unnecessary and may cause more harm
than good.

Back in the day, 25 years ago, surgeons used to bring patients into the
hospital the night before surgery, even for something as simple as a breast
biopsy. One of the main reasons for that was so that the nurses would make
sure the patient didn't eat or drink anything after midnight. When Medicare
declared such operations as breast biopsy or hernia repair as outpatient
operations, anesthesiologists had dire predictions about increased deaths
from aspiration pneumonia. Here we are 25 years later and those fears have
been shown to be just silly. Like so many things in medicine from 25 years
ago, it turned out to just be no big deal.


From: "Howard McCollister" <>
Subject: Re: Laparoscopic Surgeryy
Date: 17 Jan 2005 22:09:16 -0600
Message-ID: <41ec8b64$0$5308$>

"REP" <> wrote in message
> Well, yes that and nothing by mouth for at least eight hours greatly
> reduces the chance of peeing on the surgeon during pelvic procedures,
> whether or not that's its intent!

Irrelevant and untrue. It is extremely important that patients who are
undergoing and general anesthetic not be dehydrated. If they are, the
operation would be delayed while IV fluids are run in sufficient to bring
the patient back to a euvolemic state. Dehydrating a patient to the point
where the kidneys are not making urine is unnecessary and dangerous.
Relative to pelvic procedures, a catheter is placed in the bladder to keep
it empty. This is done not to keep the doctor from being urinated on, but to
keep the bladder empty so that it's not in the way of the procedure. A full
bladder can make most pelvic operations difficult or impossible. During
longer operations, a urinary catheter is placed so that the anesthetist can
monitor urine output to assure adequate hydration during the procedure, and
to keep the bladder from becoming overdistended, since a patient who is
under general anesthesia can't urinate.


From: "Howard McCollister" <>
Subject: Re: Laparoscopic Surgeryy
Date: 26 Jan 2005 08:43:04 -0600
Message-ID: <41f7abe5$0$64705$>

"Carey Gregory" <> wrote in message
> "Howard McCollister" <> wrote:
>>"Carey Gregory" <> wrote in message
>>> "Howard McCollister" <> wrote:
>>>>Correct - to keep the bladder from becoming overdistended, since
>>>>anesthetized patients can't urinate.
>>> Why?
>>Can't initiate the micturition reflex.
> I thought loss of conscious control would produce the opposite effect.
> Why is an anesthetized pt different from one unresponsive for other reasons
> where they often lose bladder control?

Emptying of the bladder requires a voluntary cortical initiation of a spinal
cord reflex (micturition), and it must overcome some degree of chemical
(adrenergic and cholinergic) influence. In the presence of depressed
cortical function and the absence of trauma affecting the spinal cord and/or
cortex (including siezure) the micturition reflex doesn't happen.

Answering your question requires that you define patients "unresponsive for
other reasons". In a head injury, spinal cord injury, siezure, or death, all
bets are off. Otherwise, I'm not aware of situations where loss of bladder
control happens in non-traumatized patients. If you can define some, I'll
try to answer, but it's been years since I've had to think about this stuff
and I'm hoping a smarter doctor like Dr. Fink will weigh in. Given the
thread title, I suppose it's unlikely.


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