question: Can a person in a come undergo surgery without anesthesia? If not, why?
comment: People in a coma are often able to hear, and feel pain, so anesthesia would be used. Its also why Doctors will encourage you to talk to a loved one in a Coma.
passages: Anesthesia is administered to prevent pain from an incision, tissue manipulation and suturing. Based on the procedure, anesthesia may be provided locally or as general anesthesia. Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia, the surgical site is anesthetized, but the patient can remain conscious or minimally sedated. In contrast, general anesthesia renders the patient unconscious and paralyzed during surgery. The patient is intubated and is placed on a mechanical ventilator, and anesthesia is produced by a combination of injected and inhaled agents.
   BULLET::::6. 50 years old gentleman who had undergone removal of left lung in another hospital and had developed massive air-leak from the stump had key-hole repair of the left main bronchus through mediastinoscopic approach, first time in Asia.
  
  BULLET::::7. 52 years old gentleman with artificial denture swallowed half of his denture with 8 teeth in it. It got stuck in lower part of his food pipe. In a breakthrough surgery, Dr. Arvind removed it with Robotic assistance through 3 small holes in the chest and patient was discharged on 3rd day.
   Blood or blood expanders may be administered to compensate for blood lost during surgery. Once the procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped or reversed, and the patient is taken off ventilation and extubated (if general anesthesia was administered).
  
  Section::::Description of surgical procedure.:Post-operative care.
   Choice of surgical method and anesthetic technique aims to reduce the risk of complications, shorten the time needed for recovery and minimise the surgical stress response.
  
  Section::::Description of surgical procedure.:Surgery.
   After completion of surgery, the patient is transferred to the post anesthesia care unit and closely monitored. When the patient is judged to have recovered from the anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home. During the post-operative period, the patient's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. There are several risk factors associated with postoperative complications, such as immune deficiency and obesity. Obesity has long been considered a risk factor for adverse post-surgical outcomes. It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications. If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way.
   Under certain circumstances, a general anesthetic, whereby the patient is completely unconscious, may be unnecessary and/or undesirable. For instance, with a cesarean delivery, the goal is to provide comfort with neuraxial anesthetic yet maintain consciousness so that the mother can participate in the birth of her child. Other circumstances may include, but are not limited to, procedures that are minimally invasive or purely diagnostic (and thus not uncomfortable). Sometimes, the patient's health may not tolerate the stress of general anesthesia. The decision to provide monitored anesthesia care versus general anesthesia can be complex involving careful consideration of individual circumstances and after discussion with the patient as to their preferences.
   The complications encountered during and after labral reconstruction are similar to arthroscopic procedures involving the hip.
  
  Section::::Complications.:Anesthetic complications.
  
  Anesthetic complications are rare, but include urinary retention, gastrointestinal upset, cardiac complications and even death.
  
  Section::::Complications.:Operative complications.
   Anesthesia provision in the United States
  
  In the United States, anesthesia can be administered by physician anesthesiologists, anesthesiologist assistants or nurse anesthetists
  
  Section::::Anesthesia providers.
  
  Section::::Anesthesia providers.:Anesthesiologists.
  
  Anesthesiologists are physicians (MD/DO) specializing in the practice of anesthesiology.
   Either open or minimally invasive surgery may be performed under general or regional anesthesia, depending on the extent of the intervention needed. Three approaches have been described for open surgery:
  
  BULLET::::- Lockwood’s infra-inguinal approach
  
  BULLET::::- Lotheissen‘s trans-inguinal approach
  
  BULLET::::- McEvedy’s high approach
   Section::::Anaesthesia.:Obstetric anaesthesia.
   Aside from the generalities of the patients health assessment, an evaluation of specific factors as they relate to the surgery also need to be considered for anesthesia. For instance, anesthesia during childbirth must consider not only the mother but the baby. Cancers and tumors that occupy the lungs or throat create special challenges to general anesthesia. After determining the health of the person undergoing anesthetic and the endpoints that are required to complete the procedure, the type of anesthetic can be selected. Choice of surgical method and anesthetic technique aims to reduce risk of complications, shorten time needed for recovery and minimise the surgical stress response.
   The success rate of placing an interscalene brachial plexus block ranges from 84% to 98% according to some case studies. Major complications such as seizures, cardiac arrests, Horner's syndrome, hoarseness, and inadvertent spinal/epidural anesthesia could occur and therefore, patients should be carefully monitored during the insertion of the block until the end of the surgery. Currently, data on combined usage of general anesthesia and interscalene blocks are limited. Some indications for combined anesthesia include difficult airway management and longer surgical procedures.
   The first hospital anesthesia department was established at the Massachusetts General Hospital in 1936, under the leadership of Henry K. Beecher (1904–1976). Beecher, who received his training in surgery, had no previous experience in anesthesia.
   Sometimes the use of non-invasive methods is not an option, so that the next level of minimally invasive techniques are looked to. These include the use of hypodermic injection (using the syringe), an endoscope, percutaneous surgery which involves needle puncture of the skin, laparoscopic surgery commonly called "keyhole surgery", a coronary catheter, angioplasty and stereotactic surgery.
  
  Section::::Invasive procedures.:Open surgery.
   Many types of surgery do not require the patient to be paralyzed. A patient who is anesthetized but not paralyzed can move in response to a painful stimulus if the analgesia is inadequate. This may serve as a warning sign that the anesthetic depth is inadequate. Movement under general anesthesia does not imply full awareness but is a sign that the anesthesia is light. Even without the use of paralytics the absence of movement does not necessarily imply amnesia.
  
  Section::::Causes and Risk Factors.:Light anesthesia.
   In addition to anesthesia, analgesia is often managed by anesthesiologists or is included in the considerations for anesthesia.
  
  Section::::Techniques.
  
  Section::::Techniques.:Small animals.
   Although this procedure is categorized as "minimally invasive", post-operative pain control can be quite challenging, thus requiring multi-modal pain management including epidural anesthetics. Nurses who attend these patients post operation generally concur that this operation is one of the more difficult recoveries of any operations for children.
  
  Section::::Recovery.
   There have been several cases of surgeons operating on themselves, but most often it has been in the nature of an emergency rather than experiment. Such a case was Leonid Rogozov who was obliged to remove his own appendix in 1961 while stranded in Antarctica in winter. However, the first surgeon to carry out this self-operation, Evan O'Neill Kane in 1921, did so with an element of experiment. Although Kane's operation was necessary, it was not necessary to do it himself, so that in itself was experimental. More than that, Kane wished to experience the operation under local anaesthetic before trying the procedure on his patients. Kane advocated a reduction in the use of general anaesthetic by surgeons.
   The implantation procedure itself is considered minor, and is typically performed with both local anaesthesia and moderate sedation. Patients often have post-procedure discomfort at the insertion site which is most often managed by administration of acetaminophen or a non-steroidal anti-inflammatory drug such as ibuprofen.
   Before the patient undergoes anaesthesia, the patient must confirm his/her identity, the site of operation, what procedure is to be carried out and that he/she has consented for the procedure. The site of operation must be marked if applicable. Then the presence or absence of allergies must be checked, the amount of expected blood loss discussed, and an anaesthetic safety check must be completed.
  
  Section::::Overview.:"Time Out".
   Additionally, certain medical conditions can prevent people from being candidates for laparoscopic approaches to repair. Examples of such include:
  
  BULLET::::- People who are unable to undergo general anesthesia
  
  BULLET::::- Prior major open abdominal surgery
  
  BULLET::::- People who have ascites
  
  BULLET::::- Previous radiation therapy to the pelvis
  
  BULLET::::- A complex hernia
  
  Section::::Surgical approaches.
  
  Techniques to repair inguinal hernias fall into two broad categories termed "open" and "laparoscopic". Surgeons tailor their approach by taking into account factors such as their own experience with either techniques, the features of the hernia itself, and the person's anesthetic needs.
   Laparoscopic procedures are considered a form of minimally-invasive surgery. Several small incisions, called keyhole incisions, are made. These types of surgeries are associated with shorter hospital stays than open surgery, as well as less postoperative pain and scarring and lower risks of infection and need for blood transfusion.
   Virtually every part of the body can be anesthetized using conduction anesthesia. However, only a limited number of techniques are in common clinical use. Sometimes, conduction anesthesia is combined with general anesthesia or sedation for the patient's comfort and ease of surgery. However, many anaesthetists, surgeons, patients and nurses believe that it is safer to perform major surgeries under local anesthesia than general anesthesia. Typical operations performed under conduction anesthesia include:
  
  BULLET::::- Dentistry (surface anesthesia, infiltration anesthesia or intraligamentary anesthesia during restorative operations such as fillings, crowns, and root canals, or extractions, and regional nerve blocks during extractions and surgeries)
   Safe anesthesia care depends greatly on well-functioning teams of highly trained healthcare workers. The medical specialty centred around anesthesia is called anesthesiology, and medical doctors who practise it are termed anesthesiologists. Ancillary healthcare workers involved in anesthesia provision have varying titles and roles depending on the jurisdiction, and include nurse anesthetists, anesthetic nurses, anesthesiologist assistants, anaesthetic technicians, physicians' assistants (anaesthesia), operating department practitioners and anesthesia technologists. International standards for the safe practice of anesthesia, jointly endorsed by the World Health Organization and the World Federation of Societies of Anaesthesiologists, highly recommend that anesthesia should be provided, overseen or led by anesthesiologists, with the exception of minimal sedation or superficial procedures performed under local anesthesia. A trained, vigilant anesthesia provider should continually care for the patient; where the provider is not an anesthesiologist, they should be locally directed and supervised by an anesthesiologist, and in countries or settings where this is not feasible, care should be led by the most qualified local individual within a regional or national anesthesiologist-led framework. The same minimum standards for patient safety apply regardless of the provider, including continuous clinical and biometric monitoring of tissue oxygenation, perfusion and blood pressure; confirmation of correct placement of airway management devices by auscultation and carbon dioxide detection; use of the WHO Surgical Safety Checklist; and safe onward transfer of the patient's care following the procedure.
   Section::::Complications.
  
  When performing a laparoscopic hernia repair, patients undergoing the procedure face complications such as postoperative urinary retention (PUR). 
  
  Another potential complication is requiring a second hernia repair after previously having one at an earlier time.
  
  Some complications can arise from the need for general anesthesia in having an open ventral hernia repair. Inherent risks are associated with the use of anesthesia.
  
  General complications that can occur using any method of hernia repair are:
  
  BULLET::::- problems with anesthesia dosage
  
  BULLET::::- difficulty swallowing because the stomach is too high up or esophagus is wrapped too tightly
  
  BULLET::::- heartburn
  
presuppositions: Comas and anesthesia are similar. 
corrections: Comas and anesthesia are not similar, so people in comas can still feel pain.
raw_presuppositions: Comas and anesthesia are similar.  People in comas can't feel pain.
raw_corrections: Comas and anesthesia are not similar, so people in comas can still feel pain. People in comas can still feel pain.