Surgery: Past, Present and Future

Q&A

Session 2: October 25

Cardiac Surgery & Eye Surgery
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What are the effects of aging on sinoatrial node’s sympathetic fibers?
Slowing of the sinoatrial node with age is likely related to degenerative change of the node. There is no established pattern of what happens with those specific sympathetic fibers. Dr. Sanjiv Gandhi

What are some congenital heart defects to which there still is no cure?
"Cure" is an interesting word. There are many problems in medicine, including congenital heart disease, for which we have no "cure" but extremely effective therapy which makes the problem "tolerable". There are a very few lesions in congenital heart disease where "comfort care" would be the preferred mode of therapy. None of these are written in stone and many are a combination of problems like severe pulmonary vein stenosis associated with a severe genetic chromosomal anatomy.  Dr. Sanjiv Gandhi

In the case of a bifurcation lesions that requires 2 stents, can you use the same procure to place in both stent?
This depends on the severity and location of the lesions and the exact intervention that is required, which varies by patient. Dr. Sanjiv Gandhi

Can bacteria or viruses cause serious eye damage or disease requiring surgery or resulting in permanent damage?
Yes, Both bacteria and viruses can cause damage to the eyes; The damage can be both pre-natal as in the case of the bacterial infection rubella (mothers developing rubella in pregnancy are at risk of a baby with cataracts, deafness and cardiac abnormalities) or post-natal (unless they use strict hygiene measures, contact lens wearers are at risk of developing infections from the bacterium pseudomonas and others). Viruses such as Cytomegalovirus can cross the placenta and affect the developing fetus, and Herpes can cause severe ulcers on the cornea. These are just a few examples of how bacteria and viruses are all around us and, given a chance, they can invade and multiply anywhere in the body including the eye. Dr. Christopher Lyons
Session 3: November 1

Surgical Education & Global Surgery
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It was wonderful and fascinating to hear today about the amazing versatility of the human body (ie: using rib cartilage to build an ear!!) and the surgeons’ creative ability to well utilize that versatility. Are there any structures that don’t have donor sites you can source materials from? What do you think of harvesting animal parts in those situations?

We would reject anything (eventually) if it were harvested and transplanted from an animal. We do use pig valves in heart surgery, but essentially they are just the anatomic scaffold that has been treated chemically to remove antigens. A whole pig heart (or ear, or hand) would be rejected. Even another human transplanted hand would be rejected unless the patient is treated with immune suppression medications.

For ears, there are synthetic implants (called Medpore) that are shaped like ear frameworks that some surgeons use instead of ribs, but they are always foreign material and have some increased risks.

Session 5: November 15

Anesthesia Research & Technology
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Does anesthesia have different side effects on males and females?
In general no. Young women may have more nausea with certain anesthetics

Do complications potentially increase with age?  
The very young and very old have higher complication rates.

There was a mention of fentanyl. Is it still used, despite its high addiction and dangerousness? What precautions are now being taken and will there be a change of medication to replace fentanyl?  
This is still one of the best opioid analgesics. The addiction risk is no different from other opioid analgesics. Most major surgery is very painful and will require strong painkillers (the opioid analgesics are the most powerful but are typically combined with other pain killing drugs). The major risk when fentanyl is abuse.   it is very potent and has a rapid onset (so you can easily stop breathing). These are the properties we need when we do anesthesia.

How do you deal with family separation when you travel to different countries for medical missions? When is the best time for relationships like marriage; before, during or after education/your journey to be a doctor?
You need to have a supportive family! There is no best time for these major life events.  It really depends on who your partner will be. 

You mentioned that bringing patients out of their “sleep” was the hard part that required a lot of skill. Why?  The difficulty is keeping patients asleep yet not too deep to shut down other organs of the body (like the heart). We also do not want to wait hours or days for the patient to wake up.  Wake should typically take less than 15 minutes.

If anesthesia helps us not recall memories, would it be possible to focus memories (goal – photographic memory)?
Not that we know of today.

How does the anesthetic process differ when the patient needs to be awake during the operation?  
We need to use very short acting drugs that will wear off very quickly and we need to give a very accurate dose (not too much or too little).