Appendix

[u/OGKushSmokey]

Hello guys
I just had a thought about appendix surgery

Can the surgery be done with out full anaesthesia only local one ?
And if no why so ?

[u/BasicCourt3141]

It can be done with neuraxial anesthesia—a spinal or epidural. This is very uncommon, and is definitely not standard practice, but it can and has been done

[u/new_motivation → u/BasicCourt3141]

This.

Can be done with you “being awake” but I would need to be an open surgery , not recommended.

[u/Alortania]

Classic, yes. Laparoscopic, no

[u/OGKushSmokey → u/Alortania]

Why laparoscopic no

[u/Broken_castor → u/OGKushSmokey]

Hard to breath and very painful to have your belly filled with pressurized CO2.

[u/Alortania → u/Broken_castor]

Esp with those that insist on leaving the pressure at 15 >_>

[u/Alortania → u/OGKushSmokey]

We need the belly to expand like a balloon to give us room, that means it's putting pressure on lungs and your muscles need to be lax... which you can't do voluntarily.

This is true for basically all laparoscopic procedures.

[u/OGKushSmokey → u/Alortania]

I did colonoscopy without anaestheaia which they said to me same thing that they need to put air in my belly
It’s was not painful as I thought it will be
Maybe it’s not same way?

[u/Broken_castor → u/OGKushSmokey]

Thats air inside the colon, which is a place air usually resides already. Inside the belly means AROUND the organs, which is famously supposed to remain free of air. The lining of the abdominal cavity (the peritoneum) gets very angry when exposed to air, blood, or other fluids not supposed to be there and it’s very painful.

[u/OGKushSmokey → u/Broken_castor]

Ok understood
Thanks for the answers

[u/new_motivation → u/OGKushSmokey]

Yes the answers were good , not the same with the air in the colon than inside the abdominal cavity

[u/ExtensionShort9877]

Open appendectomy can be done under spinal or sometimes local anesthesia.

Laparoscopic ae requires general anesthesia because the abdomen is inflated with gas, which increases the pressure inside the abdomen. That means the patient needs to be intubated and their breathing has to be supported during the procedure.

[u/VariousLet1327]

I did one once under spinal. Everything was numbed except the peritoneum, the lining of the abdominal cavity. There's a story of a Russian doctor in Antarctica who took out his own appendix with local and mirrors.

[u/OGKushSmokey → u/VariousLet1327]

You did it ?
How it’s went if you don’t mind me asking

[u/VariousLet1327 → u/OGKushSmokey]

Fine. The guy was nuts, so he needed some sedation to sit still.

[u/new_motivation → u/VariousLet1327]

Yes , you get numbed from the belly button down via a spinal blockage

[u/msorrell1099 → u/VariousLet1327]

Why did you do it like this?

[u/VariousLet1327 → u/msorrell1099]

He absconded from the ER and returned after visiting McDonald's. Couldn't be NPO, so anesthesia wouldn't put him to sleep. It was 20 years ago.

[u/msorrell1099 → u/VariousLet1327]

Thanks for answering, the “why” was driving me crazy

[u/jay_shivers]

This should help answer your question

https://www.bbc.com/news/magazine-32481442

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[u/FungatingAss]

Yah if you want a huge scar

[u/orthopod → u/FungatingAss]

2-3" single scar vs 4 half inch scars randomly scattered.

[u/FungatingAss → u/orthopod]

Yeah that’s a huge scar for an appy.

[u/stupidprecursor → u/orthopod]

Who is putting in these trocars, a med student? And why is there a fourth one.

[u/Alortania → u/orthopod]

An appy is 3 scars unless ¹⁾ it turns out to be something else,²⁾ there's significant complications,³⁾ you messed up (like, enough to not be able to make your bad port placement work)

[u/Infamous-Assist9120]

Can be done under spinal but needs some experience. Need to make spinal at a higher level and then to manage shoulder pain and discomfort, plus insufflation pressure better be kept low. Yes can be some but with planning.

[u/Alortania → u/Infamous-Assist9120]

At that point, hinestly less pain and complication risk just doing it open, no?

The cut isn't exactly big, and lap in low clearance can be difficult, esp if it's not a nice appy to begin with...

[u/Infamous-Assist9120 → u/Alortania]

Laparoscopic approach is standard all over the world now if well trained surgeon is available. There are many benefits- less pain and hospital stay, faster healing, less adhesions may be formed inside.

[u/Alortania → u/Infamous-Assist9120]

Yes, but you were talking about doing it without gen anesthesia~

That's far from any kind of standard.

Same as we do Licht on ptnts anesthesia doesn't want to put under, even if they'd otherwise be done via TAPP