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Bronx, New York : Anesthesia Awareness

David L. Cordray 4944 Church Street Bronx, NY 10461

When the movie “Awake” came out in theaters it sparked much controversy throughout the country about the condition also known as anesthesia awareness. Following the release of the movie, Larry King Live did a special about this issue, in which King interviewed physicians and patients who have suffered from awareness. In response to the recent influx in publicity over the issue, the DREAM Campaign has taken the initiative to interview Dr. Tong Joo (TJ) Gan, who sheds light on many concerns that patients have when considering a surgical procedure as well as the misconceptions about anesthesiology in general. With so much focus on awareness and the negative impacts of anesthesia, it is important that the public be properly informed. Awareness can be a highly unpleasant experience, but most times the alternative is a surgery with negative outcomes or even worse, death.

There are about 100 to 150 reported cases of anesthesia awareness per year in the United States. It is very difficult to get an exact figure because it is under reported. Dr. Gan shared with us a case in which a patient of his experienced anesthesia awareness. The patient had come to the Emergency Room with a gunshot wound to the abdomen. He was suffering from massive blood loss and had very faint blood pressure so the anesthesiologist had to administer a safe dosage of anesthesia that would not hinder the overall well being of the patient as well as the blood pressure. When questioned post-operatively, the patient reported that he could hear voices during a brief period in surgery.

Hearing is said to be the last sense to go and the first to return under general anesthesia. As in the case of Dr. Gan’s patient, the modifications that had to be made because of low blood pressure caused the patient to become slightly aware and that is why he was able to hear briefly during his operation. “He did not suffer from any consequences after that and in fact, he thought that it was part of the operation,” said Dr. Gan.

When asked the common question, how can a person feel pain when they are paralyzed, Dr. Gan discussed the three areas of anesthesia; paralysis which paralyzes the muscles, analgesic which block pain signals to the brain, and anesthetic which puts the person to sleep so that they do not remember anything. For this reason, a person can be physically paralyzed but they may still feel pain. The human body does have natural responses to pain such as sweating, increased blood pressure and movement which may indicate to the anesthesia care provider that they are not fully anesthetized.

New technology allows anesthesiologists to measure the brain waves of a patient even while they are under anesthesia. “By using specific monitors, one can tell how deep a person is in anesthesia,” says Dr. Gan, “It is a bit like an iceberg; if it is below the water, it is very difficult to know how deep the iceberg is, and the monitor tells you what the depth of anesthesia is even when the patient is asleep.” The Bi-spectral Index Monitor, or BIS monitor is an example of such a device. Brainwaves are measured on a range of numbers from 0 to 100 in which 0 equates no brain activity and 100 is the mental state of a person when fully awake. During general anesthesia, brainwaves are measured between 40 and 60. If the BIS monitor measures activity above 70, there is a very good chance that the patient may not be fully anesthetized.

Dr. Gan mentions several fascinating facts throughout the interview one being that genetic factors can influence the way a patient reacts to anesthesia. Studies have shown that women tend to wake up about 10 minutes sooner than men when the anesthesia is cut off. This means that women need more anesthesia in order to produce the same effect. Redheads are also said to need more as well.

The revolutionary research that is being done by researchers like Dr. Gan is vital to prevent cases of unpleasant experiences and side effects. “One of the most effective ways to try and prevent this problem is to raise awareness of this problem, no pun intended,” Dr. Gan explains, “So we educate our staff, anesthesiologists and anesthesia care providers to let them know that this problem does exist and therefore it is important to take steps as well as understand the patient to try and prevent it.” He also mentions that there are mandatory educational modules that every anesthesia care provider must take. These modules go through various aspects of educational awareness such as the incidents of awareness, the scenarios where awareness may happen, the drugs or drug combinations that would reduce the incidents of awareness as well as monitoring the inter-operative awareness.

The Department of Anesthesiology is committed to find as many ways possible to provide the best patient care. Dr. Gan’s research in particular focuses on steps that could alleviate patients from the common unpleasant side effects of anesthesia and surgery by improving patient outcomes during the perioperative (before, during and after surgery) period including anesthesia awareness, pain, nausea and vomiting, and bowel dysfunction through the use of drug and non-drug method, such as acupuncture. Our hope is that through listening to this interview, people will become educated about the issue and in turn they will be relieved of any anxiety they may face about being under anesthesia.

Dr. Gan is a professor and devoted researcher here at Duke, whose interests include Anesthetic-related Clinical Pharmacology, Inter-operative Awareness and Post-Operative Pain, Nausea and Vomiting, and using Acupuncture. He came to Duke as a visiting associate and fellow in 1993 is now serving as both professor and Vice Chairman of Clinical Research. Dr. Gan is also known for his research on the Bi-spectral Index (BIS) Monitor.

Patient Awareness Under General Anesthesia Lifeline to Modern Medicine

What is patient awareness under general anesthesia? Awareness under general anesthesia is a rare condition that occurs when surgical patients can recall their surroundings or an event—sometimes even pain—related to their surgery while they were under general anesthesia.

When using other kinds of anesthesia, such as local, sedation or regional anesthesia, it is expected that patients will have some recollection of the procedure.

Studies are not conclusive on the frequency of awareness under general anesthesia, but even one case is important to anesthesia professionals (anesthesiologists and certified registered nurse anesthetists), who recognize that this can be a distressing or traumatic experience for the patient.

When awareness during general anesthesia does occur, it is usually just prior to the anesthetic completely taking effect or as the patient is emerging from anesthesia. In very few instances, it may occur during the surgery itself. Despite the rarity of awareness, members of the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) want you to know about this possibility. These organizations have been studying this issue and are in the process of evaluating the effectiveness of various technologies and techniques to decrease the likelihood of this occurring.

Why does it happen? In some high-risk surgeries such as trauma, cardiac surgery and emergency cesarean delivery, or in situations involving patients whose condition is unstable, using a deep anesthetic may not be in the best interest of the patient. In these and other critical or emergency situations, awareness may not be completely avoidable. While the safety of anesthesia has increased markedly over the last 20 years, people may react differently to the same level or type of anesthesia. Sometimes different medications can mask important signs that anesthesia professionals monitor to help determine the depth of anesthesia. In other rare instances, technical failure or human error may contribute to unexpected episodes of awareness. The ultimate goal is always to protect the life of the patient and to make the patient as comfortable as possible. That is why it is important to have highly trained anesthesia professionals involved in your surgery.

How can it be avoided? Before surgery, patients should meet with their anesthesia professional to discuss anesthesia options. Should there be concerns regarding awareness, this is an ideal time to express them and to ask questions. Patients should share with their anesthesia professional any problems they may have experienced with previous anesthetics, and also discuss any prescription medications or over-the-counter medications they are taking.

As always, your anesthesia professional will guide you safely through your surgery by relying on his or her clinical experience, training and judgment combined with proven technology.

What You Should Know About Patient Awareness Under General Anesthesia It is quite rare. When it does occur, it is often fleeting and not traumatic to the patient. Patients experiencing awareness usually do not feel any pain. Some patients may experience a feeling of pressure. Awareness can range from brief, hazy recollections to some specific awareness of your surroundings during surgery. Patients who dream during surgery, or who have some perception of their surroundings before or after surgery, may think they have experienced awareness. Such a sensation or memory does not necessarily represent actual awareness during surgery. Experts in the field of anesthesiology are actively studying this condition and are seeking the most effective ways to prevent it. Awareness can occur in high-risk surgeries such as trauma and cardiac surgery in which the patient’s condition may not allow for a deep anesthetic to be given. In those instances, the anesthesia professional will weigh the potential for awareness against the need to guard the patient’s life or safety. The same is true during a cesarean section, particularly if it is an emergency and a deep anesthetic is not best for the mother or child.

It has been shown that early counseling after an episode of awareness can help to lessen feelings of confusion, stress or trauma associated with the experience. Researchers in anesthesiology have spearheaded developments in technology that have dramatically improved patient safety and comfort during surgery over the last 20 years. A highly trained anesthesia professional should be involved in your surgery. No technology can replace this expertise. New brain-wave monitoring devices currently being tested may prove to be helpful in reducing the risk of awareness, but they need to undergo the same rigorous scientific review process that has led to wide adoption of other medical technologies. Patients should talk with their anesthesia professional before surgery to discuss all of their concerns, including the remote possibility of awareness. These professionals work to ensure the best possible care of patients in the operating room.

Patient awareness happens very infrequently. This remote possibility should not deter you from having needed surgery. Your anesthesia professional can help you to feel comfortable and informed about your upcoming experience with anesthesia.

What does the future hold? As patient advocates, anesthesia professionals are working hard to reduce the likelihood of awareness under general anesthesia. Depending upon the type of surgery, these experts have an array of proven technologies that can be used to monitor various vital signs of the surgical patient. Extensive research is under way to develop and study new technologies, such as brain-wave monitoring, that may lessen the risk of awareness. At the present time, none of these new technologies has been perfected.

Remember—no monitoring device can replace the judgment and skill of an anesthesia professional who has years of training and clinical experience. Working together, you and your anesthesia professional can make your anesthetic experience as safe and comfortable as possible.

What should I do if I think I have experienced awareness? The American Society of Anesthesiologists urges you to talk with your anesthesia professional, who can explain to you the events that took place in the operating room at any stage of your surgery and why you might have been aware at certain times. It is important to note that a variety of anesthetic agents is often used, some of which may create false memories or no memory at all of the various events surrounding surgery. If you have distinct recollections of your surgery and want to discuss them, your anesthesia professional can help you or refer you to a counselor or to other appropriate resources.

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Santa Ana, California: What are some of the benefits of taking Butea Superba?

Terrance R. Farney 504 Alpaca Way Santa Ana, CA 92704

Summary of the major benefits of taking Butea Superba:

Butea Superba enhances the immune system to protect against infection Helps reduce the incidence of diseases associated with aging, such as: cancer, arteriolosclerosis (coronary artery disease) and osteoporosis. Lowers blood cholesterol while improving liver function Helps stabilize blood sugar levels and help prevent the onset of diabetes in adults Assist slightly in weight loss and help convert fat to lean muscle mass May help control Alzheimer's disease, lupus, AIDS, and chronic fatigue syndrome Helps with menopause, see below Helps with memory and depression May help prolong life expectancy Enhance Libido and sense of well being in women and men Another benefit of Butea Superba is that it helps stimulate the production of Testosterone and Estrogen Reduces Stress levels Help dry eyes Help fend off and fight cancer

Benefits of Butea Superba for menopausal women:

This hormone can help with menopause by enhancing estrogen production. For several decades now, Butea Superba, marketed under the name Prasterone, has been used in Europe to treat menopause related depression. In Italy a combination of Estrogen and Butea Superba, known as Astenile, is being used to treat hot flashes and other forms of menopausal discomfort. Butea Superba is a precursor of estrogen. This means some of it is converted to estrogen in the body. Supplemental Butea Superba in postmenopausal women appears to be one way of increasing estrogen levels naturally. Preliminary findings indicate that Butea Superba offers a lot of the same benefits of estrogen, without many of the potentially harmful side effects. Natural Progesterone can also help with menopause. Recent Research data reported in Edocrine Today states that data provide compelling evidence to suggest that older women with osteoporosis or those at high risk for developing osteoporosis should discuss with their physicians the possibility of taking Butea Superba supplement to improve bone health. A recent study concluded that Butea Superba in small does can elevate sexual interest and tongkat ali interest help reduce the hot flashes that are so common among menopausal women.

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Philadelphia, Pennsylvania: ‘People will come back from the dead’ Surgeon in ZOMBIE breakthrough

Lloyd V. Martel 3460 Franklee Lane Philadelphia, PA 19108

Sergio Canavero plans to carry out the first transplant of a cryogenically frozen brain to a living body.

The Italian neurosurgeon revealed the timetable as he discussed the world’s first head transplant that is due to take place in China in 10 months.

Canavero revealed he wants to do the procedure of reawakening a frozen human brain and placing it in a donor body in less than three years.

Speaking to German magazine Ooom, he said “We will try to bring the first of the company’s patients back to life, not in 100 years.

“As soon as the first human head transplant has taken place, i.e., no later than in 2018, we will be able to attempt to reawaken the first frozen head.”

And Canavero thinks his procedure could also answer questions about the existence of God, adding: “The head transplant gives us the first insight into whether there is an afterlife, a heaven, a hereafter, or whatever you may want to call it, or whether death is simply a flicking off of the light switch and that’s it.

“If we are able to prove that our brain does not create consciousness, two things will happen: religions will be swept away forever. Secondly, we will ask ourselves what the meaning of life is.

But his plans may not actually be so mad scientist.

A successful head transplant was recently carried out with rats.

The heads of smaller rodents were successfully transplanted onto the necks of larger rats it was revealed in a study published in CNS Neuroscience and Therapeutics.

Canavero wrote at the time: Testosterone butea superba alternative “Despite these exciting animal experiments, the proof of the pudding rests in human studies.”

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