Epidural
The term epidural is often used as a short form for 'epidural anesthesia'. As a first step before administration of an epidural, an IV is given with relaxing medications. The next step is that the physician numbs a small area of the skin with numbing medicine. The physician then directs a small needle using x ray guidance into the epidural space. A small amount of contrast dye is injected to insure that the needle is properly positioned into the epidural space. Finally, a small mixture of numbing medicine or anesthetic and anti-inflammatory injection is injected.
Risk of epidural during childbirth
- A mother with low platelet count may make the placement of an epidural more risky.
- Sometimes due to weight problems, it becomes impossible for an anesthesiologist to find the epidural space.
- Epidurals cannot be administered if the mother is bleeding heavily or suffering from shock.
- It is observed that sometimes epidurals can lead to fetal distress and fetal malposition.
- Increased risk of forceps or vacuum extension, episiotomy and increased risk in cesarean section is observed because of epidural use.
- A study of breast feeding mothers conducted in 2006 reveals that mothers who received an epidural were more likely to experience problems in breast feeding during the first few days after delivery.
Otoplasty
Cosmetic surgery to alter the looks of the external ears is referred to as otoplasty. Otoplasty can move, remove, add, or reshape the ear as per the individual’s choice. ENT surgeons, plastic surgeons or maxillofacial surgeons carry out this procedure. This procedure will cost about US$ 2,000 to US$ 5,000. Otoplasty is usually done when the person is aged between 4 and 14 though this surgery can be performed on adults too. This surgery produces very good results in children rather than adults as their cartilages are not as firm as adult cartilages. Through otoplasty you can:
- Bring the ears closer to the head; popularly known as ear pinning.
- Reshape any bend in the ear cartilage.
- Reduce the size of the ears if they are very big.
- Correct deformed ears or abscent-microtic ears.
Otoplasty is performed under local anesthesia combined with sedation or under general anesthesia if the surgery involves kids. Anesthesia is chosen depending on the severity of the case. Otoplasty is usually performed as an outpatient procedure and takes about two to three hours to get completed. The person can get back to normalcy after five to seven days. The ear should not be bent for about a month and the person should wear a bandage to protect the ears for about a week.
Different types of otoplasty procedures
Incision less otoplasty: Needle is positioned via the skin to sculpt the cartilage and to hold the retention sutures. One incision is made to sculpt the ear; this incision is made behind the ear. The necessary correction is carried out through this incision.
Ear reduction otoplasty: reducing the components in the ear, incisions made are not visible.
Microtia: small ear deformity can be corrected by adding components as per requirement. Reconstruction procedure is usually performed on the cartilage of the ear.
Anotia: Missing ear deformity can be corrected by adding components as per requirement. Reconstruction procedure is usually performed on the cartilage of the ear.
Risks of otoplasty
- Blood clots in the ear, it either dissolves on its own or can be removed by the surgeon.
- Infection in the cartilage, this can be treated with antibiotics.
- Numbness of the skin in the ear or the face.
- Pain for a long duration.
- Permanent scarring.
- External ear canal might narrow down.
Hemorrhoidectomy
Hemorrhoidectomy is a surgery to remove hemorrhoids - enlarged veins that is found in and around the rectum and anus. Hemorrhoids may result from straining frequently due to constipation or child birth. Hemorrhoids can be classified into two types namely - external and internal. While external hemorrhoids occur below the anal sphincter and protrude at the anus, internal hemorrhoids occur above the anal sphincter and may be classified as first, second, third or fourth degree. External thrombosed hemorrhoids cause pain and they contain clotted blood. Normally the thrombosed external hemorrhoids are incised and the clot evacuated.
Hemorrhoidectomy becomes necessary when conservative measures fail to alleviate the severe burning, itching, swelling, protrusion, bleeding and pain in the anal area. Hemorrhoidectomy becomes appropriate when there are very large internal hemorrhoids, sometimes when internal hemorrhoids continue to cause symptoms after surgical treatment, when large external hemorrhoids cause significant discomfort in the anal area.
During the surgical procedure of hemorrhoidectomy, general anesthesia or spinal anesthesia is administered on the patient so that no pain is felt. Incisions are made in the tissue around the hemorrhoid. The hemorrhoid is removed and the swollen vein inside the hemorrhoid is tied off to prevent bleeding. The surgical area could either be closed with suture or left open. Surgery is performed using a scalpel, a cautery pencil or laser. Sometimes a circular stapling device is used to remove the hemorrhoid and close the wound. Here no incision is made. The hemorrhoid is lifted and stapled into place in the anal area. Recovery from hemorrhoidectomy may take about two to three weeks.
Normally the patient experiences pain after surgery . The doctor prescribes medicine to alleviate the pain. Some bleeding is normal after hemorrhoidectomy is performed, especially with the first bowel movement. Ice packs are recommended to be applied in the anal area to reduce swelling and pain. Sitz bath, with frequent soaks in warm water helps to relieve pain and muscle spasms. Stool softeners that contain fiber may help to make bowel movements smooth.
Hemorrhoids are found to recur in about 5% after hemorrhoidectomy. Hematoma, incontinence and infection in the surgical area and fecal impaction are some of the early side effects of hemorrhoidectomy. Late problems of hemorrhoidectomy could include stenosis or narrowing of the anal canal, formation of fistula between the anal and the rectal canal and rectal prolapse when the rectal lining slips out of the anal opening.
Bibliography / Reference
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