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Hartstein: This is wonderful news

NEWS STORY
31/01/2014

Former Formula One Medical Delegate, Gary Hartstein, is buoyed by the news that Michael Schumacher's sedation is being reduced.

At a time when everyone's an expert, everyone has a view, some of the reporting of Michael Schumacher's condition and his ongoing prospects have been sensationalist drivel. Despite pleas from those directly treating him and those closest to him not to speculate this hasn't prevented the 'usual suspects' publishing meaningless rubbish aimed solely at selling a few more copies, receiving a few more hits.

Thankfully, amidst all the crap there is a lone voice of reason, an expert who truly knows what he is talking about, a man without an agenda who gives his opinion based on expert knowledge of his field. If Gary Hartstein was good enough to work with, and succeed, Professor Sid Watkins, he's good enough for us.

Having kept a close watch on the situation ever since Michael Schumacher had his accident just over a month ago, New Yorker Hartstein has kept fans abreast of how he sees things playing out courtesy of his excellent blog.

There's no drama, no desire to cause controversy, purely the view of a man who is not only an expert in the field of anaesthesiology, but a fan who has worked with Schumacher and his fellow Formula One drivers since 1989, joining Prof Watkins in the FIA medical car at Spa in 1990 and succeeding him on his retirement in 2005.

Thankfully, in the wake of the latest development, Sabine Kehm's revelation that Schumacher's sedation is being reduced in order to allow the start of the waking up process, Hartstein has taken to his blog to tell us what this means from the expert's point of view.

"Let's be unambiguous about this," he writes. "The announcement that Michael's care team is discontinuing his sedation is the news we've been waiting for. It's the first big transition - from acute, life-threatening head injury to subacute recovery. Followed no doubt, let's not forget, by a chronic rehabilitation phase. But this is wonderful news.

"In terms of how this is done, well it's actually pretty simple," he continues. "The electronic pumps driving the continuous infusions of the sedative drugs are turned off. That's it. But doing that means that the people taking care of Michael have a reasonable expectation that he will not exhibit untoward reactions to the "stress" of these medicines being turned off. The most undesirable of these would be elevations in . . . you guessed it . . . intracranial pressure, but to be honest, we're now more than four weeks post-injury, and I'd rather think that we're past that.

"So what will happen now that this stuff is turned off?

"It may or may not be true that, in general, French neurointensivists maintain sedation longer than their Anglo-Saxon colleagues. It doesn't matter. The people taking care of Michael know what they're doing.

"While it's possible that a long-acting drug may well have been used in the early, "suppressive" phase of Michael's care, it's quite likely that if so, it's been replaced with one or more short-acting substances. These usually allow signs of emergence to appear within several hours of stopping the infusions.

"What actually happens? Well in general, the first attempt to stop sedation usually gets interrupted by something. The patient gets agitated, the blood pressure goes up, the oxygen saturation goes down... something. So you turn the sedation back on, let the situation settle down, and then either try again or wait until tomorrow. It often takes a few tries before everything goes the way it should.

"How should it go? Well ideally Michael will start to want to breathe, and allow weaning from ventilatory support. And just as important of course he will hopefully start to show meaningful interaction with his environment. Following simple commands, visual tracking, etc.

"Now I've heard (from unconfirmed sources), unconfirmed reports (double "unconfirmed" should ring alarm bells of course) that Michael has indeed already done this.

"I'd love any neurosurgeons to jump in and comment, but if this indeed is true, it is fairly astonishingly good (but indeed totally conceivable) news. So I we need to cross our fingers and hope something like this DOES get confirmed in the future.

"Tell you what - let's not talk about any other alternatives right now, ok, so we keep it positive."

Why the FIA chose not to renew his contract in 2012 we'll never know - though we have our suspicions. Fact is, in recent weeks his blog posts and wise words have been invaluable and comforting for that Pitpass and its readers offers Gary its sincere thanks.

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