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Medical Forum / General / General / January 2005Laparoscopic Surgeryy
Hi, Could some one tell me how during laparoscopic removal of gall bladders are the excretory functions (urine&fecal matter) arrested or dealt with? Many thanks, Helen > Hi, > > Could some one tell me how during laparoscopic removal of gall bladders > are the excretory functions (urine&fecal matter) arrested or dealt > with? I've not had a laparoscopic cholecystectomy, but I've had pelvic laparoscopic surgeries. I was instructed to fast for eight hours prior to the procedures, but aside from that, excretory functions were not stopped by any artificial means. I believe that is true for laparoscopic cholecystecomies as well. This webiste may be helpful: http://www.gundluth.org/web/chinfo.nsf/DSPI/P07689  Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather > I've not had a laparoscopic cholecystectomy, but I've had pelvic > laparoscopic surgeries. I was instructed to fast for eight hours prior > to the procedures, but aside from that, excretory functions were not > stopped by any artificial means. I believe that is true for laparoscopic > cholecystecomies as well. The only reason you were instructed to fast is so that your stomach would be empty at the time of induction of general anesthesia, thereby (theoretically) decreasing the chance you might vomit and aspirate during induction when the airway is unprotected. Has nothing to do with excretory functions unless you're including vomiting in that category. HMc > > I've not had a laparoscopic cholecystectomy, but I've had pelvic > > laparoscopic surgeries. I was instructed to fast for eight hours prior [quoted text clipped - 7 lines] > induction when the airway is unprotected. Has nothing to do with excretory > functions unless you're including vomiting in that category. 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! Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather > 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. HMc > > Well, yes that and nothing by mouth for at least eight hours greatly > > reduces the chance of peeing on the surgeon during pelvic procedures, [quoted text clipped - 7 lines] > 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, Yes, I know that; the exclamation point is a close a smiley as I use. Obviously, I did not make my joke clear enough, and that's my fault. > but to > keep the bladder empty so that it's not in the way of the procedure. A full [quoted text clipped - 3 lines] > to keep the bladder from becoming overdistended, since a patient who is > under general anesthesia can't urinate. Interesting. Thanks. I was only really aware of the importance of not vomiting while under anesthesia. Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather > 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.....so 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. HMc >>Interesting. Thanks. I was only really aware of the importance of not >>vomiting while under anesthesia. [quoted text clipped - 24 lines] > > HMc I remember when my younger brother was born (1959) my mom was in the hospital 5 days for a normal vaginal delivery. When my daughter was born in 1996, my wife was in the hospital 4 days for a C-section. When I asked the pediatrician if this was managed care or progress, he said "a little bit of both". Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >>>Interesting. Thanks. I was only really aware of the importance of not >>>vomiting while under anesthesia. [quoted text clipped - 30 lines] > the pediatrician if this was managed care or progress, he said "a little > bit of both". Yup. It's one of the few times I can think of where third-party payors actually made a positive contribution to health care in America. HMc > Yup. It's one of the few times I can think of where third-party payors > actually made a positive contribution to health care in America. > > HMc Even a stopped clock is right twice a day. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Hi, > > Could some one tell me how during laparoscopic removal of gall bladders > are the excretory functions (urine&fecal matter) arrested or dealt > with? It's a 20 minute operation. There's nothing to deal with, and you wouldn't want to anyway. HMc > It's a 20 minute operation. There's nothing to deal with, and you wouldn't > want to anyway. > > HMc Many thanks - I imagine that if the operation goes on for any longer, for whatever reason, a catheter would be inserted. Best Regards Helen >> It's a 20 minute operation. There's nothing to deal with, and you > wouldn't [quoted text clipped - 4 lines] > Many thanks - I imagine that if the operation goes on for any longer, > for whatever reason, a catheter would be inserted. Correct - to keep the bladder from becoming overdistended, since anesthetized patients can't urinate. HMc >Correct - to keep the bladder from becoming overdistended, since >anesthetized patients can't urinate. Why? >>Correct - to keep the bladder from becoming overdistended, since >>anesthetized patients can't urinate. > > Why? Can't initiate the micturition reflex. HMc >>>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? >>>>Correct - to keep the bladder from becoming overdistended, since >>>>anesthetized patients can't urinate. [quoted text clipped - 7 lines] > 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. HMc >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. Diabetic shock, for example; urinary incontinence is extremely common. It's also not uncommon in severe septic and cardiogenic shock, and street drug ODs. >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. You're doing just fine. Welcome back to sci.med-school... ;-) > Hi, > [quoted text clipped - 4 lines] > Many thanks, > Helen I had mine removed a year ago. No problem in the suregery but....instructions were not to drink fluids after 8PM. Surgery was 11am. Was told by the scheduling nurse in the Dr's office that at best he could even be earlier at worst "a little late". They were trying to fill that spot! Figured not that much of a difficulty. Well Murphy's Gods came calling Dr. was delayed until 3PM. No water for 19 hours! That nite was hell frankly. They wouldn't let me go until I voided x amount of fluid. I had none, and they actually spoke of some type of previously unknown system problem. Hell, 19 hours, I was dehydrated. I was told that if I didn,t void I would be caterhized (my idea of hell) and could not go home until I did!. I stood numb from pain killers, swaying in the wind trying to meet thier quota in the wee morning hours! I did go home next day! Please don't misunderstand the surgery itself was remarkable and went fine with no problems afterward, but make sure you are HYDRATED.... if unsure talk to the MD www.greenmarble.blogspot.com >> Hi, >> [quoted text clipped - 22 lines] > but make sure you are HYDRATED.... if unsure talk to the MD > www.greenmarble.blogspot.com Normally, in any kind of competent surgical unit, you would have an IV started shortly after arriving. You wouldn't be able to drink or eat anything since they would want your stomach empty for the anesthesia, but it would be unconsionable if they weren't running fluid into you while you were waiting all that time. Furthermore, any competent anesthetist would make sure that you were not dehydrated prior to induction of anesthesia, and in ANY case it is an absolutely fundamental tenet of anesthesia that the patient come off the table euvolemic. There is a difference between being dehydrated and being unable to void. Frequently, the anesthetic drugs will have an anticholinergic effect, and that's especially true if atropine or similar drugs were used (as they often are). Urinary retention is a common side effect. It's not related to dehydration in any way. If your difficulty voiding before going home was truly due to dehydration, then that particular surgical unit is staffed by incompetent boobs. YOUR medical condition may have been sufficient to tolerate anesthesia in such a dehydrated state, but it's the kind of thing that KILLS older people with compromised cardiovascular systems. These are such fundamental standard-of-care issues that it's far more likely you were just unable to urinate as a drug side effect rather than being dehydrated. HMc |
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