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Gupta: Anesthesia a concern for pope


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CNN medical correspondent Dr. Sanjay Gupta
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Dr. Sanjay Gupta

ATLANTA, Georgia (CNN) -- Hours after Pope John Paul II was hospitalized with a relapse of flu symptoms, doctors performed a tracheotomy to ease the ailing pontiff's breathing, a Vatican source said late Thursday.

CNN's Kyra Phillips spoke with medical correspondent Dr. Sanjay Gupta after the operation was performed on the 84-year-old pope.

PHILLIPS: Let's talk about what the pope is going through right now.

GUPTA: A couple of things have changed now that we've confirmed that, in fact, he had the tracheotomy. I think we can safely say that this wasn't just the flu. He's probably had some inflammation -- significant inflammation -- of his upper airway as well. I think that's a pretty safe assumption now. ...

He'll probably be connected with a ventilator. This is a machine that provides breaths and takes over the breathing for the pope, at least while he's waking up from the anesthesia. It's unclear at this time. ...

We can tell you this, though, that after he wakes up, he won't be able to speak. You can't speak when you have one of these tracheotomy devices in. He still may be able to communicate in other ways -- by writing, gestures, whatnot. But it's going to be a long road. A lot of things have changed for him after this procedure.

PHILLIPS: Let's talk again about this surgery, what the pope went through for 30 minutes. You said actually the major part of that surgery is the anesthesia, not so much the procedure.

GUPTA: That's right. This is an operation performed at just about every hospital in the world.

Now, when it comes to these sorts of procedures, it's not so much the operation itself, but the anesthesia that's of concern. The operation typically involves making an incision in the neck ... then actually finding the trachea, which is just underneath the skin. ... and actually making an incision in the trachea, and subsequently placing a tube directly into the airway, which then goes down into the airway a certain depth.

Now, again, [it's] a common operation [but doctors] worry about the anesthesia. The operation [is] absolutely mandatory, though, for someone who does not have a secure airway, who is having difficulty breathing and cannot have a tube placed from the mouth.

PHILLIPS: Considering that he also has Parkinson's disease, how does that affect what he just went through and his recovery, and how well he's going to be able to communicate and function after the surgery?

GUPTA: A couple of things to keep in mind. Whenever someone has Parkinson's, the anesthesiologist is probably thinking about the best way to use general anesthesia and the best way to allow the pope to wake up from the general anesthesia, as well.

Parkinson's disease certainly can be a significant disease with regard to some of those things. Also, we've been talking so much about the fact as to why he needed this tracheotomy in the first place -- difficult to say for sure, but Parkinson's may have played a role in that as well.

While many people think of Parkinson's simply as the tremor and rigidity of muscles, it can also impair other things, including some of the muscles in the upper airway, making it difficult for him to breathe. Now, it's unclear again if any of that is actually what prompted the tracheotomy in the first place, but the fact that he has Parkinson's is probably going to make his convalescence a little bit longer, the medication choices a little bit different.

PHILLIPS: We know he was suffering from the flu, he was having respiratory problems. After having this procedure, will this help prevent the respiratory problems, the flu from getting worse, say, pneumonia or something else that could be a little more detrimental?

GUPTA: I think so. And it's an important point.

When you do a tracheotomy and you decide to do this operation, it is for a longer-term thing. No one knows that the tracheotomy will be permanent, but we're talking about leaving the device in for some time not only to secure the airway, but to allow doctors to do something they call pulmonary cleaning, actually cleaning the lungs. ...

If he develops an infection in the lungs, the tracheotomy will actually help facilitate him recovering from that more quickly. So those could all be benefits to the tracheotomy.

Again, the information has been so sparse out of the Vatican. All we know is that he was admitted with some relapse of flu-like symptoms. Some complications of the flu could be a pneumonia, could be bronchitis, could be some of these other things, but none of that has been confirmed right now.


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