At 7.15 am, the reception area of the Wockhardt Hospital in Bangalore is empty and calm. But the fourth-level, which has a row of operation theatres (OT), is buzzing with activity. In OT 7, Giridhar is wheeled in. “I am a doctor by profession. I am still scared to be on the operation table,’’ he says, with a smile.
Doctors and nurses walk in and out of the theatre with the instruments and medical records. As the staff nurses count every item brought into the theatre, the doctors scan through the patient’s medical record once again.
His medical record says: Patient came to the hospital on Monday and has been slated for a coronary artery bypass. He weighs 73 kg and is 163 cm tall. A diabetic and hypertensive, he cannot take general anaesthesia due to myasthenia gravis — weakness of the muscle.
The table is set. Chief anaesthetist Dr Murali Chakravarthy gives the test dose of the thoracic epidural anaesthesia — upper part of the spine — on the catheter that has been inserted on Tuesday evening. The monitor shows normal brain function even after 10 minutes. The heart rate and blood pressure are under control. The catheter fixed on the urinary tract also shows normal output.
The anaesthetist alerts the cardiac surgeons and administers 10 ml of local anaesthesia. “We are administering the local anaesthesia on him because he cannot take a general anaesthesia, unlike most adults his recovery rate would be very slow due to weakness of the muscles. He would require at least 10 days of hospital stay with general anaesthesia, but with local anaesthesia he can go home in less than five days,’’ he says.
The patient slowly becomes numb from neck to upper abdomen. Local anaesthesia is also given on the left leg. A team of cardiac surgeons headed by Dr Vivek Jawali cuts open his chest to reach his heart. The heart is still beating. Another team makes an incision on his right leg.
As the other doctors hold a small section of the heart with an instrument to keep it still, the veins and arteries taken from the other side of the heart and leg are carefully grafted by Dr Jawali. The new graft connects the aorta to the coronary artery, thus bypassing the blocks in the heart. “This should improve blood circulation,’’ the doctor says. And watching the blood starved heart ease with fresh blood, he smiles. "All along we have kept the heart lung machine in wraps. In a conventional surgery we might have stopped the heart, switched on the heart lung machine, cooled the body and then operated. This would have required blood transfusion as well," he says.
The doctors then wait for the nurses to complete the re-count of instruments. "Until they give us a confirmation that everything they brought in is intact, we don’t suture the patient,’’ says another doctor. The nod comes and the patient is sutured. The doctors heave a sigh. “It was a high risk surgery. In fact, it would have been even more difficult if we had chosen the conventional way,’’ says Dr Jawali as nurses prepare to wheel Giridhar to the recovery room. And even before he is out of the OT the patient quips: "I want to go home now. I feel good."