CLINICAL GOVERNANCE - PATIENT CENTRED SURGERY - THAT IS MINIMAL ACCESS SURGERY ( KEY HOLE SURGERY) DUE FOR NIGERIANS!

Dear All,

The era of big cuts into patients is almost extinct for all types of surgery from routine Open Prostatectomy, Cholecystectomy, Hysterectomy, Bariatric surgery, joint replacement, to pancreatic transplantation, Heart Valve Replacement, and so on and so on -  Anaesthesia too has become very patient friendly and centred :

It shall soon bother on best practice and ethical standards as regulatory bodies take stock if doctors continue to practice methods long ascribed to the museum of medicine:

READ ON -

Evening Standard – 30 June 2017
‘’Doctor keeps patients 'awake' for surgery in pioneering initiative that avoids risks of general anaesthetic 

Patients are being kept awake during surgery under a pioneering initiative that avoids the risks around general anaesthetic and speeds up recovery.

The ground-breaking treatment is being offered at Central Middlesex Hospital in Acton by consultant shoulder and elbow surgeon Nick Ferran.

He has performed about 50 “awake” operations since joining London North West Healthcare NHS Trust a year ago. He is believed to be the only surgeon in the capital routinely doing so on upper limb injuries.

It enables patients to watch keyhole procedures on TV screens, and allows them to be discharged earlier.

"Extraordinary" surgeon Nick Ferran with patient      Doctor Ferran at Central Middlesex Hospital

Rikki Stein who said his operation was pain-free

Some are ready to leave 45 minutes after their operation. In addition, surgery can be offered to patients who cannot have a general anaesthetic, such as a 94-year-old woman who received two new shoulders.

Mr Ferran said there were many advantages. “It avoids the need for a general anaesthetic, which can cause cardiac and breathing problems and, in very, very rare cases, death. It avoids the nausea and vomiting afterwards, which some patients can experience and which a lot of patients are worried about.

“It also allows for good pain relief because the surgical site is numb, and usually for 24 hours. It means their first night’s sleep after surgery is usually a lot more comfortable. The recovery is quicker. They can eat and drink as soon as the operation is over, and because they have got good pain relief they can usually leave hospital quicker.”

Awake surgery has been routine for hip and knee surgery for some time, and is used occasionally in neurosurgery. Mr Ferran’s patients are administered “nerve block” by consultant anaesthetist Dr Amit Saxena, who uses ultrasound to ensure the area being operated on is “bathed” in anaesthetic.

Extra pain relief and sedation are available if they start to feel pain. Patients can also be “converted” to general anaesthetic. Awake surgery is not offered to patients who cannot speak English, as they need to be able to communicate throughout.

Mr Ferran said: “There will be times when the patient might feel something sharp, or might feel discomfort, and they need to be able to tell me straight away. We have very strong painkillers that can act within 30 seconds.”

Nathan Gonzales-Brown, 19, an apprentice from Acton who dislocated his shoulder boxing, was anxious that the nerve block drugs had not worked, and was given sedatives. But 30 minutes into the procedure, he told the Standard: “I don’t feel anything. It’s quite interesting [to see it] at the same time.” 

Rikki Stein, 74, from Edgware, who was having a torn shoulder tendon repaired, said: “It’s an extraordinary experience. I was pain-free and fascinated by the whole process. The anaesthetic is extraordinary. I was aware of them doing it, but I couldn’t feel it.”

Joseph Ana.

Africa Center for Clin Gov Research & Patient Safety

@ HRI West Africa Group - HRI WA

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