Thursday, November 16, 2006
Surgery and anesthesia risks and benefits

By Dr. Anthony Policastro

There are many different reasons to have surgery. Surgeons usually explain the risks, benefits and alternatives to surgery. However, there are also risks benefits and alternatives to anesthesia. Sometimes surgery is done under local anesthesia. Sometimes, it is done under general anesthesia. Sometimes, moderate sedation is used. This means the patient is not fully asleep, but also not aware of the procedure. The type of anesthesia used depends on multiple factors. One of those factors is related to how significant the surgery is. Some surgeries are called minimally invasive. They may also be termed low surgical invasiveness. These surgeries include tubal ligation. They include cataract surgery. They include joint arthroscopy. These procedures have very few complications. They have little blood loss. They do not interfere with usual physical functioning of the body. A second group of operations are called moderately invasive. They are also known as medium surgical invasiveness. They include gall bladder removal. They include basic prostate surgery. They have few complications. They rarely require blood replacement. They do have some effect on the physical functioning of the body. The third group of operations is called highly invasive. They are also known as high surgical invasiveness. They include hip replacement. They include open-heart surgery. They include brain surgery. They have a higher rate of complications. They have a greater likelihood of needing blood. They have effects on the physical functioning of the body. So the first consideration in terms of providing anesthesia is how significant is the surgery itself. The second consideration is related to the physical condition of the patient. There are five levels of physical condition that are used. Level 1 patients are those who are normal and healthy. Level 2 are those with only mild acute disease or adequately treated chronic disease. Level 3 are those with moderate disease. Level 4 are those individuals with a disease that could be a threat to life. Level 5 are those individuals who are likely to not survive surgery. Most patients fall into Level 1 or Level 2. They are basically healthy. They are often having elective surgery. They are likely to be having minimally invasive surgery. That means that they do not need a lot of evaluation before their surgery. However, as the invasiveness of the surgery increases, so does the need for a careful evaluation before surgery. As the level of physical condition worsens, so does the need for a careful evaluation before surgery. In a level 4 patient with highly invasive procedure, the patient should expect a very thorough evaluation before surgery. The reasons for this should be obvious. One evaluation before surgery is done by the operating surgeon. That individual may need the help of consultants to make sure the patient is healthy enough for the surgery. The consultants may be cardiologists. They may be pulmonary medicine specialists. They may be of other specialties. A second evaluation before surgery is completed by the anesthesiologist. The more significant the patient's underlying condition, the more need there is to do this evaluation before the day of surgery. The more complex the surgical procedure, the more need there is to do this evaluation before the day of surgery. When both complex surgery is planned and the patient is sick, the evaluation is a necessity. A survey of anesthesiologists showed that 96 percent of them felt that a visit before the day of the surgery was necessary in patients with complex surgery and severe underlying disease. 71 percent of the same group felt that a visit before the day of surgery was necessary in patients with low risk procedures but severe underlying disease. 72 percent of them felt that a visit before the day of surgery was necessary in patient with complex surgery but little underlying disease. The bottom line is that if the surgery is highly invasive or if the patient has underlying health problems, they should expect an evaluation by anesthesiology before the day of surgery. The evaluation should concentrate on evaluation of the breathing passages. It should concentrate on evaluation of the lungs. It should concentrate on evaluation of the heart. Other items to be looked at include the list of all the patient's chronic problems. Allergies need to be evaluated. A list of current medications should be reviewed. Other things should be evaluated based upon the patient's medical history. Other tests may or may not be necessary. Surgical anesthesia is complicated. Patients should make sure they understand that aspect of their surgery beforehand. Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.

Health Bulletins

Public Health flu vaccination
Delaware's Division of Public Health announces its influenza vaccination schedule for Delawareans without a healthcare provider or whose insurance does not cover flu shots. While many DPH adult clinics accept walk in clients, DPH will vaccinate children by appointment only on scheduled days. Medicare Part B and donations are accepted. Sussex County adult clinics
Nov. 16, Thursday, Laurel Fire Hall, 205 West 10th St., Laurel, 9 a.m.-1 p.m. Walk In
Nov. 28, Tuesday Blades Fire Hall, 200 East 5th St., Blades, 4-7 p.m. Walk In
Dec. 7, Thursday, Blades Fire Hall, 200 East 5th St., Blades, 9 a.m.-1 p.m. Walk In
Children under the age of 18 will be seen by appointment only at the DPH Clinics and State Service Centers. Parents or guardians interested in making appointments for flu shots may call one of these DPH clinics.
¥ Sussex County, Georgetown State Service Center, 856-5213
¥ Sussex County, Shipley State Service Center, 628-2006
For more about flu clinic locations and dates, go to

Grotto Festival of Trees
The Alzheimer's Association Delaware Valley Chapter will participate in the Grotto Festival of Trees beginning on Nov. 20. A tree will be decorated at three locations. Virgil Ellwanger, State Farm Financial Services, will sponsor a tree at Long Neck; the Law Office of Edward C. Gill will sponsor a tree at the Grand Slam in Lewes; and LifeCare at Lofland Park's Memory Walk Team for 2007 will sponsor a tree at the Grand Slam in Seaford. Make plans to visit one of these three locations, between Nov. 20 and Jan. 1, to make your donation in support of the Alzheimer's Association to fund local programs and services. Each store will donate an additional $250 to the charity whose tree receives the most donations. You can make a difference! For more information, please call the Georgetown Branch Office at (302) 854-9788.

Young adults with cancer
The Wellness Community-Delaware is offering a support group for young adults whose lives have been affected by cancer. "Being Young with Cancer" targets issues specific to adults in their 20's, 30's, and 40's. The group encourages open discussion about their experiences and concerns, thus helping individuals feel less isolated and more in control of their lives. The support group is held on the fourth Monday of each month at 5 p.m. at the Sussex facility located at 19633 Blue Bird Lane, Suite 5, Rehoboth, off Rt. 1. The program is free, but advanced registration is required by calling 227-1155.

Delaware Hospice Festival of Trees
The festival in Georgetown is Dec. 1-3 at Del Tech. Festivities include a gala and live and silent auction on Dec. 1; and a holiday and collectibles auction as well as lunch with Santa on Dec. 2. Daily events include a gift shop, bake shop, raffles, and craft elves. General admission is $3 for adults and $1 for students.

Fundraiser at Georgia House
The Wellness Community-Delaware will hold a fundraiser on Monday, Nov. 20, at the Georgia House, 119 Main Street, Millsboro, from 5-7 p.m. The event features a buffet meal to benefit the programs of the Wellness Community that are offered free of charge to participants. Tickets are $16.95 for adults and $8.95 for children. Advanced tickets are required and must be purchased by November 16th. For more information or to purchase tickets, call 227-1155.