WK#12_IDUBAMO MONIGHA_THE CHOICE OF ANESTHESIA IN MY SURGICAL OPERATION.

Problem Statement

Over the past two years I have been troubled with irregular bowel movements and abdominal pains. I having been visiting the staff hospital on regular basis and all symptoms/earlier tests conducted did not come out with a clear cause of problem. However on the 7th March 2011, I had so much discomfort in the preceding weekend and had to visit the hospital once again. This time with luck on my side a visiting consultant surgeon was on call. He immediately asked for a new set of tests and the result was suppressed acute appendicitis and intestinal malfunction.

He then advised an immediate surgery to correct the intestinal malfunctioning and remove of the appendix. After counseling, I concurred and he referred me to the Anesthetist. I met with the Anesthetist who briefed me on the types and procedures of anesthesia administration. He then left the options open to me after discussing our discussion. As was the rule of consent, the patience is left to choose the best option.

However, the greatest challenge is what type of anesthesia to be administered. I had just 30 minutes to decide before the surgery takes place. The surgery is expected to last minimum 4hrs and is classed a major surgery.

Root Cause Analysis

Inconsistent troubled abdomen

Consistent indigestion

Unhealthy feeling

Risk to life

Nausea

Excess drug usage for suppression

Lack of peristalsis after meals for 3-5yrs

Alternatives:

A. Local anesthesia

B. Epidural and spinal anesthesia

C. General anesthesia

Analysis of Alternatives:

Alternative A: Local anesthesia – this involves injection of a local anesthetic directly into the surgical area to stop feeling of pains. This is use mainly for minor surgeries on limited parts of the body. You remain awake.

Alternative B: Epidural and spinal anesthesia – this involves injection near the spinal cord and nerves that connect to the spinal cord to block pain from an entire region of the body, such as the belly, hips, or legs. You remain awake.

Alternative C: General anesthesia – this involves administering into a vein or is inhaled. It affects the brain as well as the entire body. You are completely unaware and do not feel pain during the surgery.

Comparison of Alternatives

Local Anesthesia	Epidural and spinal anesthesia	General Anesthesia
No airway intubation (no lungs complication)	No airway intubation (no lungs complication)	Airway intubation (possible lungs complication)
suitable for minor surgeries	suitable for major surgeries	suitable for major surgeries
Applied to only affected part	applied to a specific region	Affects entire human body
Requires less personnel	Requires large personnel	Requires large personnel
Doesn't require a theatre room	Requires a theatre room	Requires a theatre room
Patient awake during procedure	Patient awake during procedure	Patient asleep during procedure
Doesn't require presence of consultant Anesthetist	Require presence of consultant Anesthetist	Require presence of consultant Anesthetist
most suitable for short surgery durations	most suitable for short/long surgery durations	most suitable for long surgery durations
No blood loss	Possible decrease in blood loss.	Increased blood loss.
no post-operative nausea/vomiting	rare post-operative nausea/vomiting	possible post-operative nausea/vomiting
Faster recovery	normal recovery	slow recovery
Surgeon not too comfortable in most cases	surgeon comfortable	surgeon not too comfortable
No post-surgery nursing care	little post-surgery nursing care	intensive post-surgery nursing care
communication with patient	communication with patient	No communication with patient
no loss of memory after procedure	no loss of memory after procedure	Possible loss of memory after procedure

SELECTION CRITERIA

Value Drivers – Anesthesia suitable for major surgery, patient fully awake, short recovery after procedure, low loss of blood, low risk from post-surgery nausea/vomiting and short stay in In-Patient Department (IPD).

Using grid analysis:

Using Grid Analysis
GRID ANALYSIS (UNWEIGHTED)
Alternatives	Drivers
	Anesthesia suitable for major surgery	Patient fully awake	Low loss of blood	Low risk from post-surgery nausea/vomiting	Short stay in IPD (admission)	Short recovery after procedure
A	1	5	5	5	5	5
B	5	5	3	3	3	5
C	5	1	1	1	1	1
LEGEND: Must for surgery procedure
High	5
Medium	3
Low	1

Using Grid Analysis
GRID ANALYSIS (WEIGHTED)
Alternatives	Drivers						Total
	Anesthesia suitable for major surgery	Patient fully awake	Low loss of blood	Low risk from post-surgery nausea/vomiting	Short stay in IPD (admission)	Short recovery after procedure
Weighting	4	2	3	3	1	2
A	4	10	15	15	5	10	59
B	20	10	9	9	3	10	61
C	20	2	3	3	1	2	31
LEGEND: Order of Importance
Very high	4
High	3
Medium	2
Low	1

Selection of Preferred Alternative.

Based on the Grid Analysis above. Alternative B ranked highest in score therefore is the preferred alternative.

Performance monitoring and post-evaluation

Post – surgery monitoring of vital signs for 6 weeks and quarterly further.

Report any occurrence of unusual body state.

Random tests to check presence of anesthesia in body system.

Perform only non-tedious physical tasks for 90days to ensure complete healing of incision.

Eat only healthy meals as prescribed by dietician to help healing process.

Undertake light exercises and have plenty of rest.

References:

The memory jogger 2 ‘Tool for continuous improvement and effective planning by Michael Brassard and Diane Ritter – Second Edition 2010.

http://www.mindtools.com/

http://www.webmd.com/pain-management/tc/anesthesia-types-of-anesthesia

http://www.faceliftboston.com/anesthesia.htm