TAVR without General Anesthesia Has Better Results
Before you have TAVR, you should find out if your surgeon is set on using general anesthesia, because moderate sedation has benefits that general does not have.
Many people fear “not waking up” after undergoing general anesthesia, and sometimes they automatically assume that this type of sedation is the only option for the surgery that they’re planning on — even TAVR.
General anesthesia requires a breathing tube while moderate sedation does not.
General anesthesia is sometimes used for TAVR.
Researchers at the Perelman school of Medicine at the University of Pennsylvania showed that moderate sedation was equally or better overall than general anesthesia for TAVR (transcatheter aortic valve replacement).
“I agree that conscious sedation is better for TAVR, as most of the patients treated with TAVR are elderly and at increased risk of cardiorespiratory complications and post-operative delirium with GA,” explains Asim Cheema, MD, who’s board certified in internal medicine, cardiovascular diseases and interventional cardiology by the American Board of Internal Medicine. Dr. Cheema is with Your Doctors Online, an online doctor chat site.
“In addition, TAVR is a minimally invasive procedure with percutaneous access and ideally managed with sedation for patient comfort and a plan for quick recovery with early ambulation post-procedure,” says Dr. Cheema.
“The multicenter 3M study has shown that in a selected population, a minimally invasive approach with conscious sedation and an expedited recovery plan allows most patients to be discharged within 24-48 hours post-TAVR.”
So why would there ever be a need for general anesthesia?
The researchers relied on the STS/ACC TVT RegistryTM — a database of TAVR patients in the U.S.
They looked at elective cases of femoral artery approach minus an incision to compare general anesthesia with moderate sedation.
This meant nearly 11.000 patients, with 1,737 having received moderate sedation.
Advantage of Moderate Sedation in TAVR
• A lower rate of mortality within 30 days of the procedure
• A lower rate of stroke within 30 days
• A shorter hospital stay
The conclusion was that moderate sedation is safe, effective and potentially the choice approach for TAVR.
This conclusion applies to all kinds of TAVR patients, not just the relatively healthy and younger ones.
What are the three levels of “moderate sedation” anyways?
• Isolated local anesthetic at the site of catheter entry
• Twilight sleep (conscious sedation) in which the patient is lightly asleep but responsive
• Monitored anesthesia—an unconscious but arousable state. In general anesthesia that patient cannot be aroused and not responsive to any external stimuli.
Your Doctors Online offers a free 7 day trial where you can ask a doctor questions online and get answers in minutes from anywhere 24/7. Learn more here. Dr. Cheema teaches and provides supervision to graduate students at the Institute of Medical Sciences, University of Toronto.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Mrs_Bazilio
Source: sciencedaily.com/releases/2016/05/160506100411.htm
Can Running Prevent Knee Replacement Surgery in Old Age?
Maybe you should start logging in those running miles to prevent a need in older age for a total knee replacement surgery.
The myth is that typical running — and I don’t mean the degree of running that competitive runners do — grinds down the cartilage between the upper and lower leg bones where they meet in the knee. (more…)
Why Do Bodybuilders Do Isolation Work If It Can’t Build Mass?
So if isolation work can’t build muscle and only compound moves can, why do big bodybuilders do a lot of isolation exercises?
Isn’t this a contradiction? (more…)
Why Obesity Is Especially Bad for Tall People
Being obese in combination with being tall creates a potential fatal medical condition that isn’t as likely in a shorter but obese individual.
You can’t change your height, but you can change your body fat percentage. The conclusion that being tall and obese may increase risk of blood clots is reported in Arteriosclerosis, Thrombosis and Vascular Biology: Journal of the American Heart Association (2010).
Body Positivity Does Not Prevent Blood Clots
So now we have yet one more reason to stop passing off excess body fat as “big bones” in a tall man and as “sexy curves” in a tall woman.
Obesity in and of itself is actually a well-known risk factor for DVT: deep vein thrombosis — a blood clot that can break loose and get into the lungs, causing a fatal pulmonary embolism.
Obesity is also an established risk for a pulmonary embolism. DVT and pulmonary embolism are collectively known as venous thromboembolism (VTE).
The report says that VTE risk is 5.28 times higher in obese and tall men; 2.57 times higher in normal-weight and tall males (at least 5′ 11.7″); and 2.11 times greater in obese but short men.
How significant was this risk increase in being both tall and obese?
The report says it’s comparable to other risk factors including oral contraceptive use and pregnancy.
What about women? The risk was 2.77 times higher in obese and tall; 1.83 times higher in obese and short; and for women over 5’6″ and normal weight, there was no increased VTE risk.
Senior study author Sigrid K. Braekkan, Ph.D., says that there actually may be a risk in “very tall” women, but there weren’t enough available for the study.
The researchers believe that the extra distance that blood must be pumped in a tall person’s calf muscle might cause reduced blood flow in the legs — raising the risk of a clot in obese individuals.
Obesity also creates increased abdominal pressure, which is believed to undermine the ability of the calf-muscle pump to return blood from the legs.
Obesity also causes persistent low-grade inflammation, which may make blood more prone to clotting.
Tall and Very Overweight? How to Lose the Unhealthy Extra Pounds.
Being tall does not make it any more difficult to reduce body fat percentage.
Thus, tall individuals should never use their height as an excuse for being “big” or “large framed,” when in actuality, they are carrying excess body fat.
As a former personal trainer, I must emphasize the importance of refusing to settle for a “big” (overweight) body just because you’re tall or just because you’ve been called “big boned” all your life.
My response to this big bone thing is this: Dinosaurs have big bones. Tall people have LONG bones. Long bones do not cause excess body fat. Overeating and under-exercising do.
To reduce the risk of blood clots (and this is for women as well), you must engage in regular strength training, focusing on large muscle groups with exercises such as the deadlift, squats, flat and incline bench press, flat and incline dumbbell press, overhead presses and pulling exercises such as the lat pull-down and seated cable row.
To further lower the risk of blood clots and fight obesity, you must engage in regular aerobic exercise plus practice portion control of the foods that you normally overeat.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Source: sciencedaily.com/releases/2011/04/110428162304.htm
Teaching Child the Lost Puppy Lure by Sex Offenders
Have you drilled your child about the lost puppy ruse that predators often use to lure children into harm’s way? You can easily teach your child not to fall for this ploy. (more…)
Why Does the Ab Wheel Make My Armpits Hurt?
That strange armpit pain you get during or after using the ab wheel is definitely coming from this little tool, and there’s a very logical explanation for it. (more…)
Cause of Hurting Knees Overnight
Do your knees feel fine when you go to bed but then in the middle of the night you awaken in pain?
How could sleeping soundly lead to knee pain?
Did you overlook a recent trauma to the knee?
“The sudden onset of knee pain could represent an acute injury [e.g., meniscus tear from a slip-and-fall] that was possibly unrecognized, such as a mild miss-step or twist that may have led to swelling and pain,” says John-Paul H. Rue, MD, orthopedic sports medicine surgeon with Orthopedics and Joint Replacement at Mercy Medical Center in Baltimore, MD.
But what if the overnight pain is in both knees or there hasn’t been any trauma?
“Knee pain can also develop suddenly if you recently started a new activity or increased your activity, such as walking a long distance or doing a new activity,” says Dr. Rue.
“An acute infection in the joint, known as septic knee, could be another cause of sudden new-onset knee pain without trauma.
“Warning signs would be swelling, pain, and increased warmth in the knee, and it is typically associated with a fever and generally not feeling well.”
A patellar tracking problem (more common in women) can also trigger pain in the knee that develops overnight, such that if you awaken in the middle of the night when nature calls, you realize “Geez, my knee!”
A tracking issue with the patella (kneecap) is usually caused by sport, and this can really hurt, though avoidance of the offending activity (which is usually running or jumping) should clear up this problem.
If your knee pain subsides once you’re up and about in the morning, it’s probably nothing to worry about.
But if the discomfort begins to occur during waking hours, you may have bursitis, osteoarthritis or chondromalacia patella (wearing down of the cartilage beneath the kneecap).
In fact, a certain kind of bursitis can cause overnight knee pain.
You may also want to experiment with different leg positions when sleeping.
Perhaps the knee is simply reacting to a less-than-ideal position overnight and gets stiff as a result.
Dr. Rue specializes in prevention and treatment of sports and exercise injuries. His primary focuses are knee, shoulder and elbow injuries including ACL and cartilage injuries, rotator cuff injuries and overuse tendonitis.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Africa Studio
If Plus Size Women Lift Heavy Will this Make Fat Cells Bigger?
Are you overweight and want to lose body fat?
Then lift heavy. Don’t make the mistake of thinking heavy weightlifting will bulk up your body. (more…)
Will Elastic Band Walking Shrink Thick Thighs?
Have you been walking sideways with a tight elastic band wrapped around your lower legs to trim your thick thighs?
Give it up; this won’t shrink your thighs. (more…)
Signs Your Ankle Is Broken vs. Badly Sprained
Okay, so you just sprained your ankle and it’s as big as a pumpkin, turning ugly colors.
Can this STILL be only a sprain or might it be broken?
Should you sit home and ice the thing all day long and keep it propped up, keeping your fingers crossed that no bones are broken?
If this is how you feel, why not just go to the emergency room? No insurance?
Don’t let that stop you.
The last thing you want, especially if you’re an athlete, is a permanently bum ankle because it wasn’t treated in a timely fashion.
Signs Your Ankle Is Broken vs. Badly Sprained
“The bottom line is that the only way to truly tell whether your ankle is broken (if there is a fractured bone) vs. just badly sprained is to get an X-ray,” says John-Paul H. Rue, MD, orthopedic sports medicine surgeon with Orthopedics and Joint Replacement at Mercy Medical Center in Baltimore, MD.
“There are certain rules that providers use, called the Ottawa Rules, which basically mean that if you have tenderness over the bones around the ankle and cannot bear weight, you need an X-ray.
“Any type of crepitus, or crunching type of feeling at the bones, or deformity of the ankle requires an X-ray, as those are strongly suggestive of fracture.”
A badly swollen ankle isn’t necessarily broken, but a broken ankle will always be badly swollen.
Fearing a Fracture
People are afraid to hear, “It’s broken.” But what most people don’t know is that the break in an ankle takes a shorter time to heal than do badly sprained ligaments.
This is true even though the break may require a plaster cast.
A really bad sprain in the absence of a break can take several months to fully heal.
Do not delay in seeking medical attention.
There is no such thing as a “wait and see” approach if a bone is broken.
Dr. Rue specializes in prevention and treatment of sports and exercise injuries. His primary focuses are knee, shoulder and elbow injuries including ACL and cartilage injuries, rotator cuff injuries and overuse tendonitis.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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