[HSF] Intimal Tears

[Edward Bender]

I don't mean to "pile on" Ani with this question, but ever since our
discussions about carotid artery surgery Ani's responses about avoidance of
medical personnel and "VOMIT" have been bothering me.  Ani, I gather from
your missives that you have the difficult job of performing a lot of
desperate operations on desperate patients.  Naturally, a lot of the
outcomes are predictably fatal, with the successes being all that much
sweeter.  Do you think that your aversion to aggressive diagnosis and
intervention has anything to do with the arena in which you perform?  I bet
that if I had to go through what you go through, I would be averse to
"looking for trouble" also.  I remember Tom Starzl commenting that he found
the renal transplant work enjoyable, and the research was challenging, but
when he started in on liver transplants, that was when the torture really
began for him.

Ed Bender, MD


On 2/4/08 5:28 PM, "Tea Acuff" <tacuff at swbell.net> wrote:

> Of course the problem with logic and prospective complications is that one can
> argue either way retrospectively. Some are stronger arguments (as in Ani's
> calculations), but none are clear.
> 
> tea
> 
> 
> ----- Original Message ----
> From: Prasanna Simha M <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Monday, February 4, 2008 10:45:19 AM
> Subject: Re: [HSF] Intimal Tears
> 
> Playing Ani's ethics game - is it ethical to postpone surgery to
> demonstrate  liabilities (which may not ever occur or if occurs may not
> change outcomes and  is in no way concerned with patient outcome ) versus
> going ahead with surgery (whose outcomes also may not change.
> Prasanna
> 
> On Feb 4, 2008 5:19 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
> 
>>> and close the rent with a purse string. The last option is remove the>
>> dilator , compress and cancel the case for 24 hours.
>> 
>> Prasanna
>> 
>> This last option has two advantages - 1) It will differentiate a carotid
>> puncture related stroke from a surgeon related stroke - you never know what
>> the anesthesiologist has done and if any drugs have been given. We recently
>> had a patient stroke after direct administration of norepinephrine and
>> propofol into the carotid artery (this was in an ICU patient with the line
>> placed by a surgeon). 2) Avoids a neck incision.
>> 
>> We had a similar case to yours in a child when I was at Harefield, where
>> we could not get the ACT to rise despite boluses and boluses of heparin. In
>> the end doing it the old fashioned way worked (directly injecting into the
>> RA). At some point in the surgery the right pleura was opened to reveal
>> white fluid (propofol) - all the medication had been going straight into the
>> pleural cavity where the tip of the line resided.
>> 
>> Ani
>> 
>> 
>> 
>> 
>> 
>>> 
> 
>