Kidney Transplant under spinal

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www.livescience.com

US man gets kidney transplant while awake

Being able to transplant kidneys using only local anesthetic could shorten patients' hospital stays and make the procedure accessible to more people, doctors say.
www.livescience.com www.livescience.com
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This is so stupid:

“The 28-year-old was discharged in under 24 hours, whereas kidney transplant patients would typically remain at the hospital for several days or up to a week.”

As if it’s somehow a function of the spinal and not him being an otherwise healthy 28yo.

I don’t work at this hospital, but I work in the same area. There are a lot of things Northwestern does well. Shameless self promotion is definitely one of them.
 
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“Most patients also have to spend several days to a week recovering in the hospital afterward. This is partly because general anesthesia can temporarily affect a patients' memory, concentration and reflexes.”

Uhhh noo, that’s because they have their flank ripped open and just had an organ transplant. Not to mention the large majority are ASA 4 patients with significant heart issues and coagulopathies.

“The new approach could also make transplant surgery more accessible to patients who are at a higher risk of complications from general anesthesia. This includes older individuals with some degree of cognitive dysfunction or heart or lung disease.”

Yeah nothing better for a patient with significant heart and lung disease than a T4 level spinal.

“Some people are also fearful of going under general anesthesia, and this could offer an alternative option.”

Again, no. Majority of people are largely afraid of being awake during major abdominal surgery. Is the anesthesiologist stating these things ******ed or does he only work 1 day a year and smell his own farts?
 
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DrOwnage said:
“Most patients also have to spend several days to a week recovering in the hospital afterward. This is partly because general anesthesia can temporarily affect a patients' memory, concentration and reflexes.”

Uhhh noo, that’s because they have their flank ripped open and just had an organ transplant. Not to mention the large majority are ASA 4 patients with significant heart issues and coagulopathies.

“The new approach could also make transplant surgery more accessible to patients who are at a higher risk of complications from general anesthesia. This includes older individuals with some degree of cognitive dysfunction or heart or lung disease.”

Yeah nothing better for a patient with significant heart and lung disease than a T4 level spinal.

“Some people are also fearful of going under general anesthesia, and this could offer an alternative option.”

Again, no. Majority of people are largely afraid of being awake during major abdominal surgery. Is the anesthesiologist stating these things ******ed or does he only work 1 day a year and smell his own farts?
Click to expand...
Favorite commentary right here.
 
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Im just now learning that you can’t do GA for ambulatory surgery. Our ASC is gonna need more spinal kits. The tonsils will be interesting.
 
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DrOwnage said:
“Most patients also have to spend several days to a week recovering in the hospital afterward. This is partly because general anesthesia can temporarily affect a patients' memory, concentration and reflexes.”

Uhhh noo, that’s because they have their flank ripped open and just had an organ transplant. Not to mention the large majority are ASA 4 patients with significant heart issues and coagulopathies.

“The new approach could also make transplant surgery more accessible to patients who are at a higher risk of complications from general anesthesia. This includes older individuals with some degree of cognitive dysfunction or heart or lung disease.”

Yeah nothing better for a patient with significant heart and lung disease than a T4 level spinal.

“Some people are also fearful of going under general anesthesia, and this could offer an alternative option.”

Again, no. Majority of people are largely afraid of being awake during major abdominal surgery. Is the anesthesiologist stating these things ******ed or does he only work 1 day a year and smell his own farts?
Click to expand...
Aren't many kidney transplants done/placed lower in the pelvis?

At least a few centers are doing them laparoscopically - that would be more problematic for the spinal. :)
 
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jwk said:
Aren't many kidney transplants done/placed lower in the pelvis?

At least a few centers are doing them laparoscopically - that would be more problematic for the spinal. :)
Click to expand...


Recipient is easy. I’d like to see them do a donor nephrectomy under spinal.
 
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Just did a laparoscopic kidney donor. Think spinal only would be possible but not fun
In other countries they do most surgeries with regional techniques only, no tube or sedation even for peds
 
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GassYous said:
Just did a laparoscopic kidney donor. Think spinal only would be possible but not fun
In other countries they do most surgeries with regional techniques only, no tube or sedation even for peds
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But those countries don’t have spoiled patients or spoiled surgeons who complain that the “patient is breathing.” They didn’t get the memo that breath is life.
 
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jwk said:
Aren't many kidney transplants done/placed lower in the pelvis?

At least a few centers are doing them laparoscopically - that would be more problematic for the spinal. :)
Click to expand...
That would be something. You would need an Ant-Man-type device to shrink the donor kidney to fit through a 10-12mm port site. Then, you would need to reverse the shrinkage once you get the kidney into the iliac fossa near the iliacs. Then proceed with the anastomoses. Genius! I'm guessing the whole process would take 6-8 hours and would result in a publication in JAMA Surgery. Heck, let's throw the robot into the mix so we can bill more!

Lap-assisted. Not laparoscopic.
 
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nimbus said:
But those countries don’t have spoiled patients or spoiled surgeons who complain that the “patient is breathing.” They didn’t get the memo that breath is life.
Click to expand...
I work with a vascular surgeon where we don’t even reverse till he leaves the room
 
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DrOwnage said:
“Most patients also have to spend several days to a week recovering in the hospital afterward. This is partly because general anesthesia can temporarily affect a patients' memory, concentration and reflexes.”

Uhhh noo, that’s because they have their flank ripped open and just had an organ transplant. Not to mention the large majority are ASA 4 patients with significant heart issues and coagulopathies.

“The new approach could also make transplant surgery more accessible to patients who are at a higher risk of complications from general anesthesia. This includes older individuals with some degree of cognitive dysfunction or heart or lung disease.”

Yeah nothing better for a patient with significant heart and lung disease than a T4 level spinal.

“Some people are also fearful of going under general anesthesia, and this could offer an alternative option.”

Again, no. Majority of people are largely afraid of being awake during major abdominal surgery. Is the anesthesiologist stating these things ******ed or does he only work 1 day a year and smell his own farts?
Click to expand...
The anesthesiologist is not wrong about Some people fearing GA. Plenty of people have this somewhat irrational fear.
Also, depending on the type of heart disease some will do better with the spinal and also could use isobaric to prevent decreased preload.
I don't see why we are ragging on another anesthesiologist here. He's not speaking crazy talk. He's making sense. You are making sense too but there are lots of gray areas here.
 
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makemoney2024 said:
The anesthesiologist is not wrong about Some people fearing GA. Plenty of people have this somewhat irrational fear.
Also, depending on the type of heart disease some will do better with the spinal and also could use isobaric to prevent decreased preload.
I don't see why we are ragging on another anesthesiologist here. He's not speaking crazy talk. He's making sense. You are making sense too but there are lots of gray areas here.
Click to expand...

What heart disease does “better with a spinal” and how, specifically?

If we’re talking the usual players people flippantly say spinals are “better” for (AI, MR, low EFers) I can create similarly advantageous conditions under GA.
 
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makemoney2024 said:
The anesthesiologist is not wrong about Some people fearing GA. Plenty of people have this somewhat irrational fear.
Also, depending on the type of heart disease some will do better with the spinal and also could use isobaric to prevent decreased preload.
I don't see why we are ragging on another anesthesiologist here. He's not speaking crazy talk. He's making sense. You are making sense too but there are lots of gray areas here.
Click to expand...
We are "ragging" on him because the "news item" makes it sound like they have discovered something new and exciting. Any case below and not including the diaphragm can be done under neuraxial. Been that way for a long time. ;)
 
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Dr. Rude said:
We are "ragging" on him because the "news item" makes it sound like they have discovered something new and exciting. Any case below and not including the diaphragm can be done under neuraxial. Been that way for a long time. ;)
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That was not my understanding for the going in on him.
And clearly this is not common place in this country and that is why it’s a newsworthy item. Look at the first comment? “But why?”
Why not?
 
Beeftenderloin said:
What heart disease does “better with a spinal” and how, specifically?

If we’re talking the usual players people flippantly say spinals are “better” for (AI, MR, low EFers) I can create similarly advantageous conditions under GA.
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And then there is still the likely possibility of additional insult to their fragile brains and the possibility of not being able to extubate them.
 
makemoney2024 said:
And then there is still the likely possibility of additional insult to their fragile brains and the possibility of not being able to extubate them.
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If a patient is so compromised from a cardiopulm standpoint that fluid shift from surgery has rendered them un-extubatable, that same patient is getting urgently intubated mid case in lateral if you did it under spinal.

Regarding post op cognitive dysfunction w/ GA vs spinal, for every study that says spinal is better, i can find another that says no difference. For example:

Regional vs General Anesthesia and Postoperative Delirium Following Hip Fracture Surgery in Older Patients

There is equipoise at best here.

If you want to do a spinal, do a spinal, if you want to do GA, do GA. Just don’t say one is better than the other when there’s no compelling data to support you.
 
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Beeftenderloin said:
If a patient is so compromised from a cardiopulm standpoint that fluid shift from surgery has rendered them un-extubatable, that same patient is getting urgently intubated mid case in lateral if you did it under spinal.

Regarding post op cognitive dysfunction w/ GA vs spinal, for every study that says spinal is better, i can find another that says no difference. For example:

Regional vs General Anesthesia and Postoperative Delirium Following Hip Fracture Surgery in Older Patients

There is equipoise at best here.

If you want to do a spinal, do a spinal, if you want to do GA, do GA. Just don’t say one is better than the other when there’s no compelling data to support you.
Click to expand...
Yeah I disagree. Seems like they did this under straight spinal. No adjunct sedation. Who actually gets that except delivering women?

The emergent intubation you are talking about if it is going to happen also has a lot to do with the fact that these people have sedatives on top of their spinals. Not just fluid shifts.

Like I implied before though, lots of gray areas.
 
makemoney2024 said:
Yeah I disagree. Seems like they did this under straight spinal. No adjunct sedation. Who actually gets that except delivering women?

The emergent intubation you are talking about if it is going to happen also has a lot to do with the fact that these people have sedatives on top of their spinals. Not just fluid shifts.

Like I implied before though, lots of gray areas.
Click to expand...
Did you read the article?
 
makemoney2024 said:
Yeah I disagree. Seems like they did this under straight spinal. No adjunct sedation. Who actually gets that except delivering women?

The emergent intubation you are talking about if it is going to happen also has a lot to do with the fact that these people have sedatives on top of their spinals. Not just fluid shifts.

Like I implied before though, lots of gray areas.
Click to expand...

In the same post you disqualify the study because they dont use sedation. Then proceed to mention how the bad outcome in question only happens if the patient gets sedation. Lol, wut?
 
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Beeftenderloin said:
In the same post you disqualify the study because they dont use sedation. Then proceed to mention how the bad outcome in question only happens if the patient gets sedation. Lol, wut?
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What? I disqualified it how? I never did. I asked why you people are ragging on the anesthesiologist in the article and said there are lots of gray areas.
So anyway don’t feel like wasting energy with this anymore. Have fun.
 
makemoney2024 said:
What? I disqualified it how?
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Beeftenderloin said:
Regarding post op cognitive dysfunction w/ GA vs spinal, for every study that says spinal is better, i can find another that says no difference. For example:

Regional vs General Anesthesia and Postoperative Delirium Following Hip Fracture Surgery in Older Patients
Click to expand...
makemoney2024 said:
Yeah I disagree. Seems like they did this under straight spinal. No adjunct sedation. Who actually gets that except delivering women?
Click to expand...
 
“Can you please relax the patient… he’s tight. I need more relaxation.”

I just laugh when OB says this.
 
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Beeftenderloin said:
If a patient is so compromised from a cardiopulm standpoint that fluid shift from surgery has rendered them un-extubatable, that same patient is getting urgently intubated mid case in lateral if you did it under spinal.

Regarding post op cognitive dysfunction w/ GA vs spinal, for every study that says spinal is better, i can find another that says no difference. For example:

Regional vs General Anesthesia and Postoperative Delirium Following Hip Fracture Surgery in Older Patients

There is equipoise at best here.

If you want to do a spinal, do a spinal, if you want to do GA, do GA. Just don’t say one is better than the other when there’s no compelling data to support you.
Click to expand...


I haven’t done a kidney transplant since residency but we did them supine.
 
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makemoney2024 said:
Wait what? Relax a patient with a spinal?
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One of my highlights from residency was an ortho-bro asking for more relaxation during a THA under spinal. So I told him not possible, he’s not paralyzed, he’s got a spinal. He looked over to his rep with a “help me” look in his eyes, and the rep shrugged his shoulders and said “yeah, you and I were chatting in the room while he did the spinal”
 
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kidthor said:
Everything.
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Nah. I just don’t get off ragging on colleagues who make sense but have differing viewpoints on ways to conduct anesthesia. It’s a big egotistical.
But why am I surprised on a forum where most claim superstars and scores in the 99th percentile in everything and make 99th percentile in income. 😂😂😂😂
 
When I was in 'Nam ...

Saw quite a few kidney transplants done under spinal. It was the standard.

Driven by cost. It's a $2 anesthetic. Patients did fine.

I bet they're laughing at the silly Americans who've discovered this novel technique.
 
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pgg said:
When I was in 'Nam ...

Saw quite a few kidney transplants done under spinal. It was the standard.

Driven by cost. It's a $2 anesthetic. Patients did fine.

I bet they're laughing at the silly Americans who've discovered this novel technique.
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This is the whole point and why people are throwing shade at the article and anesthesiologist. There’s just nothing remotely novel, impressive or advantageous about what they did. It’s a big nothing burger that they’re trying to dress up like it’s cutting edge stuff.
 
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pgg said:
When I was in 'Nam ...

Saw quite a few kidney transplants done under spinal. It was the standard.

Driven by cost. It's a $2 anesthetic. Patients did fine.

I bet they're laughing at the silly Americans who've discovered this novel technique.
Click to expand...


A friend who did some volunteer work in Vietnam said the anesthesiologists there frequently use 29g spinal needles.
 
nimbus said:
A friend who did some volunteer work in Vietnam said the anesthesiologists there frequently use 29g spinal needles.
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Don't recall what they used but I could see that working given how small/thin most of their patients are.

Now if these doofuses at Northwestern published something about their success with 29g spinal needles in some BMI 40 'Mericans, that's a technique I'd read about with interest. :)
 
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nimbus said:
A friend who did some volunteer work in Vietnam said the anesthesiologists there frequently use 29g spinal needles.
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That's atypical. Most of the rest of the developing world uses 22g Quinckes. Nobody cares about a little headache.
 
Maz777 said:
That would be something. You would need an Ant-Man-type device to shrink the donor kidney to fit through a 10-12mm port site. Then, you would need to reverse the shrinkage once you get the kidney into the iliac fossa near the iliacs. Then proceed with the anastomoses. Genius! I'm guessing the whole process would take 6-8 hours and would result in a publication in JAMA Surgery. Heck, let's throw the robot into the mix so we can bill more!

Lap-assisted. Not laparoscopic.
Click to expand...
Ah simple semantics. A surgeon would never admit it. :)
 
sevo00 said:
Haha i had an ob ask me this. My response was ok sure let me get my tube out so I am intubate. She quickly changed her tune
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Must be in their OB textbooks somewhere - or at least in C-Sections for Dummies.
 
sevo00 said:
Haha i had an ob ask me this. My response was ok sure let me get my tube out so I am intubate. She quickly changed her tune
Click to expand...

I have had this request probably more than a hand full of times in my career. Really shows a level of misunderstanding with regards to what happens at the top of the bed. 😂
 
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