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Year View| Summary| Highlights| Month View| Wednesday 28 August 2002 (Day View) – Pleurodesis operation

28.08.2002Wednesday 28 August – I had my pleurodesis operation

I was woken up and showered with antiseptic stuff, and put on my operation gown. I was then wheeled to the theatre around 7:30 AM and promptly anaesthetised. They told me they were giving me something to make me more relaxed, so I wasn’t expecting the anaesthetic, just a pre-anaesthetic relaxant or something, but it must have been the real stuff as I was out. The operation apparently took around an hour and forty-five minutes. The first thing I remember was waking up in the post-op recovery ward shaking uncontrollably and some people telling me I’d had an allergic reaction to the intermediate-duration, nondepolarizing, skeletal muscle relaxant drug Atracurium. I was wheeled back to the ward at 12:20, apparently passing Dad and Mum. Mum burst into tears at the sight of me, although I wasn’t aware of that at the time. I was apparently “sleepy and confused and on morphine”. I’d had two chest drains placed, and a third hole in my back which was used for the keyhole style surgery during which they had roughed up my lung lining and chopped some lung out and removed some scar tissue. As the doctor said: “left video assisted thorascopic surgery, lysis of adhesions, wedge resection of left upper lobe, scar and bleb tissue and mechanical pleurodesis. Recovery was hampered by repeated pneumothoraces and failure of lung to expand, requiring insertion of second drain. These problems eventually subsided”
I was on some rather unpleasant drugs during and after the operation, and these are the ones I was told about and can remember.
Morphine has a rather large list of potential side effects, including respiratory depression, and less frequently, circulatory depression, apnoea, shock and cardiac arrest secondary to respiratory and/or circulatory depression, constipation, nausea, vomiting, light-headedness, dizziness, sedation, dysphoria, euphoria, and sweating, oedema, antidiuretic effect, chills, muscle tremor, muscle rigidity, flushing of the face, tachycardia, bradycardia, palpitation, faintness, syncope, hypotension, hypertension, dr. mouth, biliary tract spasm, laryngospasm, anorexia, diarrhoea, cramps, taste alterations, urine retention or hesitance, reduced libido and/or potency, weakness, headache, agitation, tremor, uncoordinated muscle movements, seizure, paresthesia, alterations of mood (nervousness, apprehension, depression, floating feelings), dreams, transient hallucination and disorientation, visual disturbances, insomnia, increased intracranial pressure, pruritus, urticaria and other skin rashes, blurred vision, nystagmus, diplopia and miosis. It is also highly addictive and may cause psychological and physical dependence. Technically, it’s morphine sulphate, occurring as white, feathery, silky crystals, cubical masses of crystals, or white crystalline powder; it is soluble in water and slightly soluble in alcohol. Chemically, morphine sulphate is 7,8-didehydro-4,5-epoxy-17-mtehyl-morphinian-3, 6-diol sulphate(2:1)(salt)pentahydrate.
Ketamine hydrochloride is a nonbarbiturate anaesthetic chemically designated (±)-2-(o-Chlorophenyl)-2-(methylamino) cyclohexanone hydrochloride, and does similar things to morphine, but with an additional warning: Emergence reactions have occurred in approximately 12 percent of patients. The psychological manifestations vary in severity between pleasant dream- like states, vivid imaginary, hallucinations, and emergence delirium. In some cases, these states have been accompanied by confusion, excitement, and irrational behaviour, which a few patients recall as an unpleasant experience. The duration ordinarily is no more than a few hours; in a few cases, however, recurrences have taken place up to 24 hours postoperatively. No residual psychological effects are known to have resulted from use of ketamine. In order to terminate a severe emergence reaction the use of a small hypnotic dose of a short-acting or ultra-short-acting barbiturate may be required. I was interested to see the use of postoperative there, which seems to infer that Ketamine is only given during and shortly after an operation – I was on it for a long time after mine. Molecularly it’s C₁₃H₁₆ClNO•HCl.
Kefzol, which I started 28 August, is a sterile semisynthetic cephalosporin for intramuscular or intravenous administration. Chemically cefazolin sodium, 5-Thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid, 3-[[(5-methyl-1,3,4-thladiazol-2-yl)thio]methyl] -8-oxo-7-[[(1H-tetrazol-1-yl)acetyl]amino]–, monosodium salt (6R-trans), and molecularly C₁₄H₁₃N₈NaO₄S₃.
Zantac, also started 28 August, seems positively pleasant after the dire warnings on some of the above. Its empirical formula is C₁₃H₂₂N₄O₃S•HCl. It is actually ranitidine HCl, a histamine H2-receptor antagonist. Chemically, N[2-[[[5-[(dimethylamino)methyl]-2-furanyl]methyl]thio]ethyl]-N¢-methyl-2-nitro-1,1-ethenediamine, hydrochloride, it is a white to pale yellow, granular substance that is soluble in water and has a slightly bitter taste and sulphur-like odour.
Heparin (started 28 August and stopped 31 August) inhibits reactions that lead to the clotting of blood and the formation of fibrin clots both in vitro and in vivo. is a heterogeneous group of straight-chain anionic mucopolysaccharides, called glycosaminoglycans having anticoagulant properties. Although others may be present, the main sugars occurring in heparin are: a-L-iduronic acid 2-sulfate, 2-deoxy-2-sulfamino-a-D-glucose 6-sulfate, b-D-glucuronic acid, 2-acetamido-2-deoxy-a-D-glucose, and a-L-iduronic acid.
Friendly old Paracetamol, something that I wasn’t too scared of, technically acetaminophen, 4’-hydroxyacetanilide, and is a non-opiate, non-salicylate analgesic and antipyretic which occurs as a white, odourless, crystalline powder, possessing a slightly bitter taste, and is molecularly C₈H₉NO₂.
Tramadol hydrochloride is a centrally acting analgesic. The chemical name for tramadol hydrochloride is (±)cis-2- [(dimethylamino)methyl]-1-(3-methoxyphenyl) cyclohexanol hydrochloride, but that is too hard for a normal human to pronounce.
Brufen (started 31 August), which is actually ibuprofen, which is actually (±)-2-(p-isobutylphenyl) propionic acid. It is a nonsteroidal anti-inflammatory agent.
Ciprofloxacin is a synthetic broad-spectrum antimicrobial agent, complexly represented as 1-cyclopropyl-6-fluoro-1, 4-drhydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylic acid, and empirically as C₁₇H₁₈FN₃O₃.
Naloxone, a narcotic antagonist, is a synthetic congener of oxymorphone. It’s present as naloxone hydrochloride, (–)-17-Allyl-4, 5a-epoxy-3,14-dihydroxymorphinan-6-one hydrochloride, or C₁₉H₂₁NO₄•HCl.
Maxalon and Tropisetron were also tried at various times to combat my nausea.
Comment by Ned – Sunday 24 August 2003, 3:17 AM
  Anyone using an older browser, such as Internet Explorer 6, may notice that some characters aren’t displaying correctly. They’re subscript numbers, and it seems Internet Explorer, for one, doesn’t have them in it’s character set. Mozilla does, so if you’re concerned, go check it in that.

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