Operation observations

Several weeks ago now a close friend had a breast reduction operation. I had accompanied her on most of her journey from initial consultation to the big day itself. We researched the procedure together and I assisted in the planning. I was also helping her after the operation until she was fully up and about. This was the culmination of over 20 years of wanting this procedure. She is now feeling vastly more confident in herself and she looks great.

Naturally I am not posting anything that would personally identify her (or me) but I felt that some on this forum might be interested in commenting on the anaesthetists observations during my friend's time in theatre. See the chart here:

http://www.zity.biz/index.php?mx=gallery;ox=showalbum;ax=5848

Sorry it is blurred - low light in the hospital room. I think all went smoothly and certainly her recovery was quick and uneventful. I was there when she was brought back to ber room crom the recovery room and she was fairly alert and feeling pretty well.

We have talked in detail since about her whole experience, from being taken into the anaesthetic room to waking in recovery. I don't think she shares any med fet but she spoke freely and quite eagerly about it. We had also watched plenty of videos on youtube beforehand.

A couple of things struck me however. She wasn't catheterised during surgery, which we both had expected due to the length of time in theatre. Also, I often wonder why her heart rate and blood pressure dipped so low in the early part of the operation. Any comments would be welcome.

What bra size was she and what was her newly desired size?

One of my cousins who is my age, slim and about 5'2" was a really big 36DD and had back problems. She had a body like Kate Upton. She also had to see a corsetiere to have custom made bras that cost a fortune because nothing in the stores would fit her well. She always looked top heavy. A few years ago, she underwent a reduction to her desired size of 34B and she feels great and looks great too.

She was a 36F and is now a 36C. Whilst she wasn't especially "big" she felt increasingly uncomfortable physically in recent years. More than that, however, she felt very self conscious for a long time. The confidence boost it has given her is incredible. Im so proud of what she did. She was really quite scared about the surgery but she did well.

Hi thingsekg I expect the drop in the heart rate and the blood pressure resulted from her being over-anesthetized which can result in the drop to both of these parameters. In addition she was given atracurium ( a muscle relaxant) and morphine and both of these can have similar effects.

With regards to the catheter i suspect that they inserted it and removed it in theaters, its commonly done. Plus with the anesthetic and atracurium she would not have bladder control.

Thank you for the explanation. I presume that would be a fairly normal reaction and her heart rate levelled off as the drug wore off? Or would that have been an issue that needed to be corrected? To me, it is really interesting to see the records of the time she was in theatre. I was able to explain some of it to her.

She needed to use the bathroom very soon after getting back to her room, around 45 to 50 mins after the operation and said she felt no stinging or burning so we assumed she did not have a catheter. She felt as though they had not inserted one.

Hi thingsekg yes its a fairly normal reaction for the drop in the Blood pressure and heart rate during the initial phase of the surgery and for it to leveled off during the procedure. Remember on induction they use drugs normally Propofol and Suxamethonium (induction agent and short acting muscle relaxant) for insertion of the ET tube.This can cause a drop in the Blood pressure and heart rate, once intubated they would then change over to gas ( isoflurane, sevoflurane and desflurane, or nitrous oxide ) and oxygen/air to keep you under for the surgery.

During surgery your heart rate and blood pressure constantly changes depending on factors like analgesics ( pain relief), muscle relaxants, blood loss, fluid administration ( colloids (blood and blood products like FFP's, plasma expanders etc) or crystalloids ( non blood products, Hartman's solution, saline etc)) as well as how deeply or lightly you are anesthetized.

In addition as the surgery comes to an end the level of sedation under the GA has to be reduced in order to wake the patient up from the surgery. In you friend's case you will note from the chart that she was given Alfentanil 500mcg, Propofol 180mg and Atracurium 40mg ( just about when the second B/P and Pulse was taken) this would definitely result in a drop of both those parameters.

With regards to an issue that needed to be corrected I don't think any was found looking at her B/P and Pulse, they were fairly consistent no episodes of a Hypovolemic Shock (fast heart rate low B/P) or Tachycardia ( fast heart rate) or Hypotension ( low B/P). Seems a fairly standard surgery and anesthetic.

With regards to the Catheter its difficult to say normally on the anesthetic chart they would indicate whether a catheter was placed or not. So it difficult to draw a conclusive result. Like i mention it could have been done and removed at the end of the procedure. The entire procedure took about 3hr 45mins approximately ( from the anesthetic chart ) so I'm not entirely sure if they did or did not, but suspect that they may have as its very common to do so in theaters. As regards for the burning and stinging when she peed it itself is not conclusive either way.

Most importantly the procedure was done without any complications and the end result was pleasing to her and that's the overriding factor .

@RN1993 thank you for a detailed explanation. They were just some things that I had wondered about since the operation.

She is indeed pleased with the result and it is wonderful seeing her "new" self. Her recovery was very good indeed - comfortable, very little pain and surprisingly quick overall. Of course, she had a very attentive "nurse" in me, which surely helped!!

Wow, go your friend! That is awesome! Sadly I can not see the picture now but I hope I can soon. I have always been fascinated by surgery. That is neat they let you watch some of her procedure. 😃