Why the patient in coma can't be have an operation?

Answer 1

There is no specific reason that a patient in coma could not have an operation. In fact, there are situations where patients in coma absolutely HAVE to undergo surgery!

"Coma" is a condition involving unresponsiveness. A patient in coma is failing to react appropriately to neurologic stimulation. They are not speaking or showing signs that they are understanding. They are demonstrating reduced capacity or no capacity to move away from painful stimulus. Coma is the result of either direct injury to, or biochemical illness of the brain.

In some cases, surgery is absolutely required on comatose patients. Typically, the types of surgical procedures that are done for comatose patients involve the attempt to save their lives. Sometimes comatose patients require neurosurgery (brain surgery) to help reduce the pressure causing the coma. Sometimes the coma is indirectly related to illness and infection that originated in another part of the body and that infection needs to be surgically cleaned out. Sometimes the coma is a result of brain injury in an accident where other injuries occured at the same time. These other injuries may independently require surgery for life or limb saving reasons prior to the patient coming out of the coma.

"Elective surgery" involves operations that need not be performed immediately in order for benefit. Surgery that needs to be performed immediately is "emergency surgery". Emergency surgery involves conditions that are changing rapidly, like internal bleeding or spreading infection. Elective surgery can be life saving, but it involves conditions that are not rapidly changing. Repairing hernias, removing cancers, bypassing blood vessels with severe narrowing... these are examples of things that are necessary and even life-saving, but they can be scheduled at any time.

The reason that its important to distinguish between emergency and elective surgery is that we attempt to obtain and document that the patient CONSENTS to undergo the surgical procedure. Typically a surgeon will discuss with the patient why they recommend surgery, what the surgery involves, and what the risks are. The patient then signs a form that they agree to undergo the operation. Comatose patients cannot participate in this process.

In the case of emergency surgery, we can attempt to contact the patient's family members and try to obtain consent from them, but if none are available, the emergency surgery is not delayed. We proceed under the "doctrine of implied consent". This is a legal concept which entails that it is generally agreed that we should assume that people want to have their lives saved, if they are unable to say otherwise because of being unconscious. For emergency surgery, the doctor will just write a note explaining why they need to do surgery, that they tried to find someone from the patient's family to talk to but failed to do so, and then they will proceed to do the operation.

For elective surgery, since there is no time pressure, there is no good mechanism for documenting some sort of consent with comatose patients. Very few situations occur where elective surgery would be recommended for a patient who is comatose, but this does happen, and when it does, its a problem! At times, a court appointed guardian needs to be assigned in order to make the process legitimate. Examples of situations that might exist needing elective surgery on a comatose patient include things like placing surgical breathing tubes (tracheostomies) or surgical feeding tubes (gastrostomies) into chronically unconscious people who do not appear to be waking up.

Sometimes we get people like this who are injured in accidents, they are homeless, they have no identification papers, and their fingerprints are not in the police files. We have no idea who they are, what their name is, and where they might have family. It can be a real problem.

Answer 2

Coma is a serious condition caused by critical illnesses like
Uremic coma
Diabetic coma
Hepatic coma
Cerebrovascular accident
Head injury and so on.
Elective surgery is not done on a critically sick person or else anesthesia kills the patient.

Answer 3

That would depend on the reason of the coma, sometimes can and other times not---the physician in charge has to make decision at the time..there are many reasons for comas.

Answer 4

Comatose patients DO have surgery.

If you have a specific patient in mind, there may be other factors which preclude surgery and/or anesthesia.