Eye operations “in a dream” - to sleep or not to sleep - that is the question
I think the temptation to change for the better after sleep is a natural desire. I fell asleep toothless - I woke up toothy. He fell asleep blind - woke up keenly. Well, and the like. And if the fear of doctors and medicine as a whole is added to this, then correcting something “in a dream” becomes a completely logical decision. How are we, ophthalmologists? How to make a person sighted "in a dream"?
So, what I write in this post is for those who have doctors who cause heartbeat and fear. Who is afraid of pain.
The fact that ophthalmology can offer today and in which cases “medication sleep” is necessary and when it is excessive and harmful.
Let's see what we mean by the word "drug sleep." The medical term is anesthesia. That is, an artificially induced reversible state of inhibition of the central nervous system, in which sleep occurs, loss of consciousness and memory, relaxation of skeletal muscles, and reduction or shutdown of reflexes.
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There is no local anesthesia. Anesthesia is always common. Depends on the type of injection - into the vein or "breathe" gases. The main purpose of anesthesia is to slow the body’s response to surgery, especially the sensation of pain. If the operation is not painful - anesthesia is not needed!
Surgeries for which only local anesthesia is needed and for which sleep-anesthesia is not needed:
Why? Let me explain with the example of ReLEX SMILE - I wrote about it here .
The time spent in the operating room takes only 10 minutes, half of the time it takes to “freeze” drops of the eye surface. Then the patient after installing the "spring" and irrigation on the cornea is moved under the laser. The surgeon is at this time in 10-20 centimeters from you, you hear his voice, all the space around is open.
When moving under the laser, you are asked to look at the "green light" in front of the operated eye for only 25 seconds!
This is an important 25 seconds, during which the "lens" -the lens in the thickness of the cornea is formed. This process is not at all painful, it does not feel at all, only the visual image changes. The first 15-20 seconds the green light is clearly visible, the last 10 seconds it becomes blurred, and your task is simply to continue to look in the same direction by inertia. Everything! Next 1.5-2 minutes of “fog” in front of the eye, but you are already near the surgeon - you can talk and move, some patients at this time talk about themselves, their profession or where they came from. The geography of my patients is huge and just here you will learn a lot of interesting things!
What is the harm if it happens "in a dream"? Accuracy suffers from centration!
If the patient sleeps in anesthesia, then the correct concentration does not occur. All laser correction operations require patient participation - in the case of SMILE, the correct cone centering occurs along the Purkinje light reflex. This is a light beam on the patient's cornea, and it does not always coincide with the geometric center of the pupil (we can fix it with some devices).
If the patient is in a state of drug sleep, such reflex alignment is not possible. You have to perform by anatomical landmarks - in this case, the accuracy is reduced. And if there is also astigmatism, then we need markings for cyclotortion (rotation of the eye). Then even less accurate. And if the patient snores, you have to deepen the anesthesia or change its type.
And what about LASIK or PRK - yes, everything is the same, even worse.
During these procedures, the patient must look at the flashing light - sometimes the laser operating time is 50-60-80 seconds - at this time the correct positioning takes place due to what you are looking at where it is said. If you sleep, the surgeon manually centers you again on anatomical landmarks, which do not always coincide with yours. Even with SMILE, the alignment takes place once - after the fixation with a cone, the eyes are fixed, and during LASIK / femtoLASIK fixation and centering at the expense of the surgeon all the time the laser works.
Why? There are no nerve endings in the lens, and in the standard version of the operation there are fast 10-15 minutes. Eye drops are instilled, which freeze the surface and allow the surgeon to work comfortably and not experience discomfort to the patient. At this time, the patient is "present" at the operation, hears and performs simple commands of the surgeon, from sensations he feels watering and sees the light in front of the operated eye. There are no painful sensations. Very often I talk with patients during such operations, I give some advice - then time flies by.
What causes us, ophthalmologists, to perform operations with anesthesia for medical reasons:
1. operations that require constant persistent blood pressure and lowering it at the surgeon's command: for example, through cornea transplantation or operation on the vitreous body and retina.
It looks like this - using a trephine like a tin can open an eyeball. For some time, the eye remains in the "open sky" state - and at this time, an increase in intraocular pressure cannot be allowed. The surgeon must quickly put a “patch” in the form of a donor cornea and restore the integrity of the eye. Why this is necessary - read here: Keratoplasty - the last option is to fix the eyes .
Removal of a cloudy cornea
The "patch" of a transparent donor cornea
Or surgery for diabetes with weak vessels also require a decrease in pressure — lower pressure — less bleeding from the vessels.
2. Operations in which there are painful moments caused by the course of the operation. For example, these are operations for strabismus or retinal detachment. In these cases, the surgeon "pulls" for the eye muscles or presses the eye outside (the need for these cases) - it will be uncomfortable and better at this time to be under anesthesia.
Then the operation is faster and more accurate - this is also an argument.
3. Operations that are performed for people with common diseases, for example, the elderly. When the patient's condition requires constant maintenance of vital functions.
4. If the patient is not able to perform simple tasks of the surgeon and does not understand their meaning - for example, does not know the language (you can use a translator). Eye surgery is performed with general anesthesia for children and elderly people with brain damage.
5. We can offer anesthesia for those who have a long-term operation and have back problems - you need to relax your muscles.
With anesthesia, I performed the ReLEX SMILE first in Russia and second after a surgeon from Egypt a couple of years ago. It would seem - where is the logic? I write that it is not very cool and I continue to do sometimes.
“Primum non nocere, seu noli nocere, seu cave ne laedas” - “First of all - do no harm, or be afraid not to harm” - this is one of the medical postulates.
And the logic is that technically it can be done. Only such efforts are needed quite rarely.
1000 eyes in 2-4 cases. When problems with the psyche or intelligence, with the musculoskeletal system or the vascular system - in short, strictly according to the indications.
Using anesthesia and offering it as a blessing is unethical. Anesthesia is an additional serious intervention in the body (there is no “small” anesthesia), which reduces the accuracy of the correction due to objective circumstances beyond the control of the surgeon. It’s like shooting from a cannon on a sparrow.
The surgeon should always discourage you from anesthesia during laser correction, and not call it "good." I have to explain all the arguments “against”, if the motive is just a fear of the operation.
Morale - anesthesia is not needed for laser vision correction - you are exactly able to just lie quietly for 25 seconds! Do not read the old stupid sites that it hurts or scary.
If you are worried, tell your surgeon about it and from the arsenal of light soothing preparations you will find something that will help you calm down.
In other cases - rely on your surgeon and choose the best together!
So, what I write in this post is for those who have doctors who cause heartbeat and fear. Who is afraid of pain.
The fact that ophthalmology can offer today and in which cases “medication sleep” is necessary and when it is excessive and harmful.
Let's see what we mean by the word "drug sleep." The medical term is anesthesia. That is, an artificially induced reversible state of inhibition of the central nervous system, in which sleep occurs, loss of consciousness and memory, relaxation of skeletal muscles, and reduction or shutdown of reflexes.
')
There is no local anesthesia. Anesthesia is always common. Depends on the type of injection - into the vein or "breathe" gases. The main purpose of anesthesia is to slow the body’s response to surgery, especially the sensation of pain. If the operation is not painful - anesthesia is not needed!
Anesthesia is not needed
Surgeries for which only local anesthesia is needed and for which sleep-anesthesia is not needed:
1. Operations for laser vision correction. For them absolutely do not need anesthesia! On the contrary, it is harmful. And for all types of laser correction, including modern SMILE
Why? Let me explain with the example of ReLEX SMILE - I wrote about it here .
The time spent in the operating room takes only 10 minutes, half of the time it takes to “freeze” drops of the eye surface. Then the patient after installing the "spring" and irrigation on the cornea is moved under the laser. The surgeon is at this time in 10-20 centimeters from you, you hear his voice, all the space around is open.
When moving under the laser, you are asked to look at the "green light" in front of the operated eye for only 25 seconds!
This is an important 25 seconds, during which the "lens" -the lens in the thickness of the cornea is formed. This process is not at all painful, it does not feel at all, only the visual image changes. The first 15-20 seconds the green light is clearly visible, the last 10 seconds it becomes blurred, and your task is simply to continue to look in the same direction by inertia. Everything! Next 1.5-2 minutes of “fog” in front of the eye, but you are already near the surgeon - you can talk and move, some patients at this time talk about themselves, their profession or where they came from. The geography of my patients is huge and just here you will learn a lot of interesting things!
What is the harm if it happens "in a dream"? Accuracy suffers from centration!
If the patient sleeps in anesthesia, then the correct concentration does not occur. All laser correction operations require patient participation - in the case of SMILE, the correct cone centering occurs along the Purkinje light reflex. This is a light beam on the patient's cornea, and it does not always coincide with the geometric center of the pupil (we can fix it with some devices).
If the patient is in a state of drug sleep, such reflex alignment is not possible. You have to perform by anatomical landmarks - in this case, the accuracy is reduced. And if there is also astigmatism, then we need markings for cyclotortion (rotation of the eye). Then even less accurate. And if the patient snores, you have to deepen the anesthesia or change its type.
And what about LASIK or PRK - yes, everything is the same, even worse.
During these procedures, the patient must look at the flashing light - sometimes the laser operating time is 50-60-80 seconds - at this time the correct positioning takes place due to what you are looking at where it is said. If you sleep, the surgeon manually centers you again on anatomical landmarks, which do not always coincide with yours. Even with SMILE, the alignment takes place once - after the fixation with a cone, the eyes are fixed, and during LASIK / femtoLASIK fixation and centering at the expense of the surgeon all the time the laser works.
2. Operations on the front section of the eye for cataracts and glaucoma and other problems
Why? There are no nerve endings in the lens, and in the standard version of the operation there are fast 10-15 minutes. Eye drops are instilled, which freeze the surface and allow the surgeon to work comfortably and not experience discomfort to the patient. At this time, the patient is "present" at the operation, hears and performs simple commands of the surgeon, from sensations he feels watering and sees the light in front of the operated eye. There are no painful sensations. Very often I talk with patients during such operations, I give some advice - then time flies by.
Anesthesia as a boon
What causes us, ophthalmologists, to perform operations with anesthesia for medical reasons:
1. operations that require constant persistent blood pressure and lowering it at the surgeon's command: for example, through cornea transplantation or operation on the vitreous body and retina.
It looks like this - using a trephine like a tin can open an eyeball. For some time, the eye remains in the "open sky" state - and at this time, an increase in intraocular pressure cannot be allowed. The surgeon must quickly put a “patch” in the form of a donor cornea and restore the integrity of the eye. Why this is necessary - read here: Keratoplasty - the last option is to fix the eyes .
Removal of a cloudy cornea
The "patch" of a transparent donor cornea
Or surgery for diabetes with weak vessels also require a decrease in pressure — lower pressure — less bleeding from the vessels.
2. Operations in which there are painful moments caused by the course of the operation. For example, these are operations for strabismus or retinal detachment. In these cases, the surgeon "pulls" for the eye muscles or presses the eye outside (the need for these cases) - it will be uncomfortable and better at this time to be under anesthesia.
Then the operation is faster and more accurate - this is also an argument.
3. Operations that are performed for people with common diseases, for example, the elderly. When the patient's condition requires constant maintenance of vital functions.
4. If the patient is not able to perform simple tasks of the surgeon and does not understand their meaning - for example, does not know the language (you can use a translator). Eye surgery is performed with general anesthesia for children and elderly people with brain damage.
5. We can offer anesthesia for those who have a long-term operation and have back problems - you need to relax your muscles.
Noli nocere - do no harm
With anesthesia, I performed the ReLEX SMILE first in Russia and second after a surgeon from Egypt a couple of years ago. It would seem - where is the logic? I write that it is not very cool and I continue to do sometimes.
“Primum non nocere, seu noli nocere, seu cave ne laedas” - “First of all - do no harm, or be afraid not to harm” - this is one of the medical postulates.
And the logic is that technically it can be done. Only such efforts are needed quite rarely.
1000 eyes in 2-4 cases. When problems with the psyche or intelligence, with the musculoskeletal system or the vascular system - in short, strictly according to the indications.
Using anesthesia and offering it as a blessing is unethical. Anesthesia is an additional serious intervention in the body (there is no “small” anesthesia), which reduces the accuracy of the correction due to objective circumstances beyond the control of the surgeon. It’s like shooting from a cannon on a sparrow.
The surgeon should always discourage you from anesthesia during laser correction, and not call it "good." I have to explain all the arguments “against”, if the motive is just a fear of the operation.
Morale - anesthesia is not needed for laser vision correction - you are exactly able to just lie quietly for 25 seconds! Do not read the old stupid sites that it hurts or scary.
If you are worried, tell your surgeon about it and from the arsenal of light soothing preparations you will find something that will help you calm down.
In other cases - rely on your surgeon and choose the best together!
Source: https://habr.com/ru/post/441758/
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