Awake kidney transplants
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At Northwestern no less. Shorter stay - next day home - no opioids, no intubation.
https://www.cbsnews.com/news/surgeons-perform-first-known-awake-kidney-transplant/
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I fail to see why this is "news."
A kidney transplant is a relatively simple operation, usually.
Hook up the ureter, the artery and the vein. Drop it in the belly and you're done. In the dark ages I worked with a surgeon, Jim Wolf, who could do a transplant in an hour.
The hard part is the immunology after the transplant.
He had a spinal anesthetic - just like a c-section, a hernia, whatever.
No. Big. Whoop.
"Our hope is that awake kidney transplantation can decrease some of the risks of general anesthesia while also shortening a patient's hospital stay."
Umm, Doc? Is spinal anesthesia safer than general anesthesia?
Let's find out:
Is spinal anesthesia safer than general anesthesia?
The safety of spinal anesthesia versus general anesthesia can depend on various factors, including the patient's health, the type of surgery, and the expertise of the anesthesiologist. Here are some general considerations:
Advantages of Spinal Anesthesia:
- Reduced Risk of Respiratory Complications: Spinal anesthesia avoids the need for intubation and mechanical ventilation, reducing the risk of respiratory issues such as pneumonia, aspiration, and airway trauma.
- Less Impact on Cognitive Function: There is typically a lower risk of postoperative cognitive dysfunction and delirium, especially in older adults.
- Better Pain Control: Spinal anesthesia can provide superior pain control during and after surgery, reducing the need for opioids and their associated side effects.
- Lower Risk of Nausea and Vomiting: Patients often experience less postoperative nausea and vomiting compared to general anesthesia.
- Stable Hemodynamics: There is generally less fluctuation in blood pressure and heart rate during surgery.
Advantages of General Anesthesia:
- Suitability for Longer or More Complex Surgeries: General anesthesia is often more suitable for longer or more invasive surgeries, where spinal anesthesia might not be effective for the entire duration.
- Patient Comfort: General anesthesia ensures the patient is completely unconscious and unaware during surgery, which can be more comfortable for procedures that might be distressing.
- Controlled Airway: In cases where airway management is critical, general anesthesia allows for complete control of the patient’s airway.
Risks and Considerations:
Spinal Anesthesia Risks:
- Hypotension: A drop in blood pressure can occur due to sympathetic nerve blockade.
- Post-Dural Puncture Headache: This can occur if cerebrospinal fluid leaks from the puncture site.
- Nerve Damage: Though rare, there is a small risk of nerve injury.
Infection or Bleeding: There is a risk of infection or bleeding at the injection site.
General Anesthesia Risks:
- Respiratory Complications: Higher risk of complications such as pneumonia, aspiration, or difficult intubation.
- Cardiovascular Events: Potential for significant fluctuations in heart rate and blood pressure, which can stress the heart.
- Cognitive Dysfunction: Higher risk of postoperative cognitive dysfunction, particularly in elderly patients.
- Allergic Reactions: Potential for allergic reactions to anesthetic agents.
Summary
Overall, spinal anesthesia is often considered safer for many patients due to its lower impact on respiratory and cognitive functions and better pain control. However, for certain surgeries, particularly longer or more complex ones, general anesthesia might be more appropriate. The choice between spinal and general anesthesia should be made collaboratively by the patient, surgeon, and anesthesiologist, considering the specific circumstances of the patient and the surgery.
There's a lot of stuff that's wrong in this answer, for example, the risk of allergy to general anesthetics is not zero, but very close to it. Never seen one.
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So, I looked up Jim Wolf.
A native of Chicago, he graduated from Grinnell College in Iowa before receiving his MD degree from the University of Illinois at Chicago in 1961. Dr. Wolf completed a fellowship in transplantation surgery in 1966 at the Medical College of Virginia. During this time, Dr. Wolf trained under David M. Hume, MD, an early leader in the field of organ transplant surgery. From 1967 to 1976,
he served on the faculty at Virginia Commonwealth University. In 1968 he was appointed chair of surgery at McGuire VA Hospital in Richmond, Virginia.In 1976 Dr. Wolf joined Northwestern University Medical School as professor of surgery and chief, division of transplantation surgery, and associate dean for medical education. He also served as director of transplantation surgery at Northwestern Memorial Hospital. He retired in 1994.
Dr. Wolf founded the Gift of Hope Organ and Tissue Donor Network in 1986. He also played a leading role in the nationwide United Network for Organ Sharing and helped create a network to fairly distribute organs for transplants based on those with the most need. So strongly did he believe in this system that, when he was in need of a transplant of his own, he placed himself on the waiting list. He waited several months before receiving a lifesaving heart transplant in 2001.
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I used to joke that lung transplant centers were few and far between but you could get a new kidney at any Walgreens.
@jon-nyc said in Awake kidney transplants:
I used to joke that lung transplant centers were few and far between but you could get a new kidney at any Walgreens.
You're right. At Northwestern, back in the day, we didn't do a lot of kidney transplants, but enough to have a viable program. The biggest problem was the awkward hours - "Gotta get that new bean in before it dies!" - rather than the complexity of the surgery.
By the time I left, the lung transplant program was just getting started. It was a nightmare. Fortunately, I wasn't involved with those pioneers.
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By the way, did you happen to notice that they talked to the surgeon who did the procedure, including his photograph, but they never mentioned the name of the anesthesiologist who actually enabled this “groundbreaking thing “to happen?
Not that I’m bitter, of course.
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@Mik said in Awake kidney transplants:
Ah…now I know why you’ve been so grumpy about this…
Well, I'm right, aren't I?
By the way...
https://www.cbsnews.com/news/surgeons-perform-first-known-awake-kidney-transplant/
Editor's note: This procedure was the first of its kind for Northwestern Medicine, not the first ever. The story and headline have been updated.
