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Medical Advances See Anaesthetists Take On Riskier Patients

Fuseworks Media
Fuseworks Media

14 OCTOBER 2008 - The obese, the medically unwell and the elderly are undergoing lifesaving surgery they would have been refused for 20 years ago.

New Zealand Society of Anaesthetists president Andrew Warmington says better training, modern equipment, better monitoring of patients under anaesthesia and after it, safer drugs and newer anaesthetic gases have all enabled anaesthetists to take on riskier patients successfully.

Two decades ago he says anaesthetists would have shied away from risky patients, particularly the elderly and the obese.

"We're dealing with patients who, 20 years ago when I was a registrar, would not have got an anaesthetic and the survival rates are excellent."

Patient safety is one issue that will be discussed at the Australian Society of Anaesthetists and the New Zealand Society of Anaesthetists combined scientific congress being held at the Wellington Convention Centre from October 11-14.

"We now anaesthetise older patients than we used to, and older people often have other major medical problems that can impact on an anaesthetic like heart disease," says Dr Warmington.

"And now we are being asked increasingly to provide anaesthesia to extremely obese patients who, 20 years ago, people would have shied away from because they pose technical issues we can now meet due to advances in skills and technology."

Almost 250,000 people have an anaesthetic every year and for patients over 60 the risk of dying from an anaesthetic complication is about one in 60,000 operations. This compares to one in 8000 in the 1950s and 60s.

While Dr Warmington says one death is always one too many, the low death rate has meant anaesthetists have been able to focus on injury prevention, morbidity and illness.

"A serious consequence would be a brain injury through lack of oxygen, which is rare, but then there's nausea and vomiting which are minor medically but are a major issue for the patient and may lead to an extended hospital stay.

"Between those two extremes are possible injuries from anaesthesia, injuries to nerves, either from the way the patient is positioned or injury from needle insertion, eye injuries which aren't common but are potentially severe, and, more commonly, teeth injuries."

Dr Warmington says the society is trying to increase awareness of common injuries and illnesses.

He says part of young trainees' training is prevention of anaesthetic complications and awareness of such prevention strategies while for more experienced anaesthetists it's more about learning how to use new pieces of equipment or administer new drugs.

Other topics to be covered at October's scientific congress include ways to de-stress patients ready for surgery, medical emergencies mid-air and magic with an ethical twist.

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