lets say a person wants to go into coma for whatever reason for two months, he finds a shady doctor in a shady underground hospital because hospitals won’t do it
how long can the doctors safely medically induce him into coma for?
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It’s not the going in or staying in that’s the problem. It’s the coming out.
A medically induced coma consists of a sedation drip, usually a pain control drip, and then occasionally, a paralytic drip. These drips keep the patient asleep, out of pain, and paralyzed, so that they don’t move. You don’t always need the paralytic, but occasionally.
Our lungs work on a negative pressure system. Chest wall expands, air gets sucked into the lungs. In a medical coma, a patient is on a ventilator, which is a positive pressure system that pushes air into the lungs. The longer you’re on the vent, receiving positive pressure ventilations, the harder it is to come off. Your body may struggle to remember how to breathe.
Tube feeding and a foley / rectal tube will take care of nutrition and voiding. That part is the easy part really.
Loss of muscle tone is going to be an issue. If you don’t use it, you lose it. Part of why being an astronaut is so hard on the body. Muscle tone isn’t being sustained because it’s not being used.
The other issue is going to be avoiding hospital acquired infections. Hospitals are full of sick people. Sickness travels quite easily in a hospital. Pneumonia takes out lots of people on ventilators, because the bacteria gets down in their lungs and just sits there. No movement, no coughing, just laying there.
So to answer your question? Indefinitely, probably. However, there’s bound to be an upper limit where you probably couldn’t bring them back out of a coma. Modern medicine is incredible at keeping people who shouldn’t be alive, alive. The problem is, there’s no use keeping someone alive indefinitely, if they won’t have any quality of life afterwards.
ELI5: So you know how your legs fall asleep when you sit on the toilet for a long time? You can sit on the toilet forever, but the longer you sit, and the harder your legs fall asleep, the harder it is to standup afterwards. You can sit on the toilet for a really long time, but if you sit on it too long, we’re afraid that you won’t be able to stand back up, because your legs are too asleep.
TL;DR at the bottom.
>how long can the doctors safely medically induce him into coma for?
There are two very important words here: “coma” and “safely”.
The word “coma”, despite its popularity in the public consciousness, is not really a word that is used in the medical community. It has no fixed meaning and being unconscious or having a reduced level of consciousness has a number of different reasons, all of which might be described by non-physicians as “coma”.
When physicians give medications to patients to reduce their cancer consciousness, we describe this as being along a continuum of states. The commonly accepted levels of medication-induced reduction in consciousness are.
+ Minimal sedation (sometimes called.anxiolysis, or anxiety reduction).
+ Doctors use this when a patient is anxious or mildly uncomfortable about something. An example would be giving a pill (such as Xanax / alprazolam before having a cavity filled. The patient has a reduction in nervousness, but they remain awake, and have no alteration in body functions or protective reflexes.
+ Moderate sedation (sometimes called conscious sedation).
+ Doctors use this when performing an uncomfortable or painful procedure that doesn’t require deeper levels of anesthesia. Having a broken bone or dislocated joint put back into proper position, or a wisdom tooth extracted are common indications for this. In moderate sedation, the patient often appears to be sleeping, but they can respond to being spoken to or physically stimulated. Often they do not remember the procedure. Vital functions such as breathing and the circulation of blood are preserved.
+ Deep.sedation.
+ In deep sedation, patients.will require repeated physical stimulation to respond. Often spontaneous breathing is impaired, and some kind of ventilatory support is necessary. Protective reflexes are severely impaired, so, for instance if a patient vomited, they would not be able to properly expel the vomit and keep their airway clean. The circulation of blood usually is not affected. This is used for longer or or painful procedures.
+ General anesthesia.
+ In general anesthesia, the patient is unable to respond at all to verbal or physical stimulation. Their breathing is severely impaired or absent. Their ability to properly circulate blood may be impaired. They have no ability to clear their airway, even saliva can be a problem. This level of analgesia is generally used for major surgery, such as having a joint replaced, or an organ removed.
Generally, when someone is sick enough to need to be made unconscious for a prolonged period of time, deep sedation is the general level of anesthesia that is used. Periods of lighter anesthesia can be used to see if the patient is ready to be awakened.
Now let’s get to the second word: safely. There is nothing inherently safe about any of this. It is absolutely not safe to be “placed in a coma”. I’m assuming that, based on the question, we are talking about prolonged deep sedation. This would involve a constant infusion of medications and being placed in a machine to breathe, including a tube that goes through the mouth or nose down into the trachea, which is the body’s pathway to the lungs.
This hypothetical patient would not be able to eat or drink, of course, and would have to be fed through tubes in the nose, and an IV line All of their typical body functions would have to be monitored, and interventions made to help, such as having a bowel movement – not pooping is a.common but very serious issue in these cases. Urination would be impaired and a tube would have to be placed in the bladder.
All of these tubes can cause problems; infections, physical damage. The tubes can fail to work and have to be replaced, and the placing of the tubes can also cause damage.
Patients are unable to protect themselves from other damage, they cannot tell when they are uncomfortable, so it’s very frequent for them to develop bed sores, and a careful regimen of turning the patient and examining for the development of such sores is necessary.
Patients develop muscle wasting very very quickly and recovering from even a few days of deep sedation can be very difficult. Patients will often have difficulties performing simple tasks after being awakened from deep sedation, getting out of bed, walking to the bathroom, performing their standard tasks like getting dressed can be very very difficult.
Severe confusion is common after being awakened from deep sedation, one of the terms for this is “ICU psychosis” and it can last for days or even weeks.
For unclear reasons, patients who have been sedated for prolonged period of time develop neurologic issues, called ICU polyneuropathy, where the signals from their brain to their muscles are disrupted, not only are the muscles themselves weak from prolonged inactivity, but the nerves themselves stop functioning properly, leading to prolonged weakness, prolonged difficulty with sensation.
# TL;DR
Patient placing a patient in a “coma” is inherently unsafe. There is no safe period of time that this can be done.
Since your question is about a shady Dr in a shady hospital, then the answer will be for as long as you have money to keep the staff and drugs flowing.
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