General anesthesia equivalent to running a marathon?

[likeaboss]

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I was talking to an anesthesiology attending and she was saying that the amount of physiologic stress put on a patients heart and major organs during general anesthesia is equivalent to running a marathon. I know it's purely theoretical, but have you guys heard this before? If so, in what sense is it true? I just think its a very interesting way of looking of general anesthesia if it is true...

 

[BobBarker]

I thought we were going to talk about the longest time in a case. I finished the last 15 hours of a free flap, once. It had started around 6 hours prior to me taking over.

 

[Bertelman]

I was talking to an anesthesiology attending and she was saying that the amount of physiologic stress put on a patients heart and major organs during general anesthesia is equivalent to running a marathon. I know it's purely theoretical, but have you guys heard this before? If so, in what sense is it true? I just think its a very interesting way of looking of general anesthesia if it is true...

Only if you're doing it wrong.

 

[MD Dreams]

Maybe if you have a ruptured AAA or something like that. In general, major vascular cases are considered the highest intra operative insult to the body. I think the ologist was trying to butter things up a bit.

 

[cchoukal]

I guess it depends on your metrics. Based on hemodynamics and oxygen consumption of major organs, "general anesthesia," as provided by an inhalational or balanced technique, should not only be less stressful than a marathon, but should be less stressful than everyday living.

In a marathon, your muscles, brain, and heart dramatically increase their oxygen consumption. Your HR and BP increase quite a bit as well. Cortisol increases.

Under GA, your CMRO2 decreases, as does your myocardial oxygen consumption, assuming you've appropriately controlled the patient's hemodynamics. In fact, there's a lot of data suggesting that inhalational anesthetics "pre-condition" one's myocardium to the stress of ischemic insults, as in uncontrolled tachycardia.

It's possible that there are some hormonal changes that more closely mimic those experienced during a marathon. It's also possible that there's some other way to quantify "stress" that I'm not aware of, but by the traditional metrics, I don't think your attending's statement holds water.

 

[sevoflurane]

200mg of Sux would make you feel like you just got done with a marathon.

 

[jumpingforjoy]

How about when heart rate remains relatively elevated as if you're awake even though you're supposedly sleeping and heart rate should drop?

 

[Idiopathic]

ridiculous.

 

[periopdoc]

How about when heart rate remains relatively elevated as if you're awake even though you're supposedly sleeping and heart rate should drop?

When does that happen?

-pod

 

[proman]

Maybe if you have a ruptured AAA or something like that. In general, major vascular cases are considered the highest intra operative insult to the body. I think the ologist was trying to butter things up a bit.

I'm pretty sure running your entire blood volume through 7 feet of bare plastic every minute is more of an insult.

 

[loveoforganic]

When does that happen?

-pod

REM?

 

[btbam]

200mg of Sux would make you feel like you just got done with a marathon.

 

[Narcotized]

.

 

[dhb]

the amount of physiologic stress put on a patients heart and major organs during general anesthesia is equivalent to running a marathon.

If you're running four busy rooms it is.

 

[AirBubble]

When does that happen?

-pod

First night on cell block 4 with Bubba?

 

[periopdoc]

If you're running four busy rooms it is.

👍

-pod

 

[aneftp]

If they can complete a marathon in less than 4 hours we can be safe to suffice a stress test is not needed to further evaluate them for any type of surgery.

Just remember we've had patients pass stress test and have MIs later. Nothing is guaranteed. But running a marathon is very stressful on the body.

That's why you have seen supremely conditioned athletes die of IHHS usually 20 miles in the race or longer. Most collapse near the end. Never seen an ihhs marathon runner collapse near the beginning.

 

[Idiopathic]

Typically, the functional ability required to tolerate general anesthesia is the ability to walk up 2 flights of stairs. The functional ability required to run a marathon is the ability to run 26 miles. You tell me which is going to tax you more??

certainly not true. we like for people to be able to do this as a sign of acceptable physiologic reserve, but I guarantee most of my patients during residency could not have done this (or would not have tried.)

 

[IDBasco]

I was talking to an anesthesiology attending and she was saying...

You sure it wasn't a CRNA?

 

[Narcotized]

.

 

[aneftp]

What I usually find funny (well not funny) but idiotic of trial lawyers is when they say how "healthy as an ox so and so is" and Vioxx "killed" this person in the prime of the lives.

I've never seen a report of an ASA 1 5'10 22 year old male death from Vioxx. It's always these patients with high cholesterol, previous documented coronary artery disease, obese, diabetic.

Even look at John Ritter of 3's company fame. He died. He was obese, a heavy tobacco user and they tried to present him as a healthy patient.

Crap happens during surgery. Even following standards and guidelines, things will happen and they will find a way to sue you.

 

[Idiopathic]

What I usually find funny (well not funny) but idiotic of trial lawyers is when they say how "healthy as an ox so and so is" and Vioxx "killed" this person in the prime of the lives.

I've never seen a report of an ASA 1 5'10 22 year old male death from Vioxx. It's always these patients with high cholesterol, previous documented coronary artery disease, obese, diabetic.

Even look at John Ritter of 3's company fame. He died. He was obese, a heavy tobacco user and they tried to present him as a healthy patient.

Crap happens during surgery. Even following standards and guidelines, things will happen and they will find a way to sue you.

vioxx was shown to increase the risk of MI for patients with coronary artery disease, and Merck essentially lied about the results. that doesnt equate to the situation where someone who is already sick just happens to die from their underlying sickness. you can argue with the manner in which things are presented, but the truth of the matter is it increased risk of death in patients with otherwise stable medical conditions.

john ritter had a missed aortic dissection. in theory, his life could have been saved with prompt diagnosis and treatment. the physicians were not found liable, by the way.

isnt your presentation of information just as bad as what you accuse the trial lawyers of doing?

 

[aneftp]

vioxx was shown to increase the risk of MI for patients with coronary artery disease, and Merck essentially lied about the results. that doesnt equate to the situation where someone who is already sick just happens to die from their underlying sickness. you can argue with the manner in which things are presented, but the truth of the matter is it increased risk of death in patients with otherwise stable medical conditions.

john ritter had a missed aortic dissection. in theory, his life could have been saved with prompt diagnosis and treatment. the physicians were not found liable, by the way.

isnt your presentation of information just as bad as what you accuse the trial lawyers of doing?

Not that I have ever been involved in a malpractice case (yet)....knock on wood.

But a couple of my collegaues have. At trial it's all about misinformation and all a show for the jury.

Yes I am aware about John Ritter's verdict. The hospital had settled with the estate so even though the doctors were not liable. The estate probably still got a 3-5 million dollar settlement from the hospital itself.

Yes Merck was wrong. I agree. But it's been completely over blown. Name me one case of healthy young person who had any adverse effects with Vioxx.

There are many layers of blame with Merck and it involves the FDA also. But at the same time we must continue to encourage innovation.

 

[Idiopathic]

Yes Merck was wrong. I agree. But it's been completely over blown. Name me one case of healthy young person who had any adverse effects with Vioxx.

so healthy young people are the only ones who deserve civil protection from the courts?

 

[Idiopathic]

edit: not worth continuing