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Doctors at Chicago-based Northwestern Medicine think kidney surgery is due for a wake-up call—literally.
Though general anesthesia is the norm in these procedures, some patients have health issues that make it riskier, such as an allergy, a severe phobia, or a history of adverse reactions. So the health system has established the AWAKE (Accelerated Surgery Without General Anesthesia in Kidney Transplantation) kidney program. It gives patients the option of getting a spinal anesthetic alongside a milder sedation that calms them while keeping them awake.
Doctors performed Northwestern’s first kidney transplant with this method in May and have done three total, with more scheduled over the next few months, spokesperson Mark Rudi told Healthcare Brew on August 12.
Patients, so far, are on board.
“My recovery has been very smooth. I was walking and eating solid foods the same day as my surgery, and I walked a half mile around my neighborhood the day I got home from the hospital,” said one of the patients, Harry Stackhouse, 74, in an August 7 Northwestern press release.
Stackhouse was a good candidate for the program because his age and end-stage kidney failure put him at increased risk for side effects from general anesthesia, such as heart issues.
Zooming out. Though this summer’s awake transplants were a first for Northwestern, the concept isn’t new. A number of other hospitals have done this before, including the University of Kansas.
It’s still better for most patients to undergo general anesthesia, Randeep Kashyap, surgical director of the Kidney and Pancreas Transplant program for the University of Rochester Medical Center, told Healthcare Brew. He said some patients in his career have requested a transplant while awake, but he didn’t end up doing it because there was no medical reason to forgo general anesthesia.
“It’s not that we would not be open to doing it, but we never had a patient that we needed to do it in the spine,” Kashyap said, noting that the risk of internal bleeding can be higher with spinal anesthesia.
Though there’s limited research, one of the largest investigations on how regional anesthesia affects kidney transplants was a 2005 study of 50 patients in Turkey. The groups were randomly assigned to receive general anesthesia or combined spinal and epidural anesthesia for their kidney transplants.
The study monitored surgical time, heart rate, and blood pressure, as well as the frequency of bradycardia and hypotension, and found no difference between the groups.
Northwestern, too, is finding this method to be just as safe, if not safer.
“It really opens up a whole new door and is another tool in our toolbelt for the field of transplantation,” Satish Nadig, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center, said in a June 24 press release.