Personal CPAP Machines in PACU of Uncertain Benefit

OkyDoky,

I am really trying hear what you're saying but all the articles I have seen disagree with you, including this one:

http://www.outpatientsurgery.net/outpat ... ews--05-07

"We found that these patients wake up in PACU more fully awake than those who don't receive CPAP," says respiratory therapist Karl Ludwig, RRT, who adds that CPAP decreases carbon dioxide and helps patients wake up, while those without CPAP are more prone to a carbon dioxide-enhanced narcosis. "Patients we put in CPAP aren't falling back into that deep sleep mode after they get their pain meds because they're more awake after surgery."

This was referring to the fact that patients were put on the machine as soon as they arrived at the recovery room.

49er

OkyDoky wrote:

cathyf wrote: (Which I suppose is unfortunately on topic to the assertion that medical staff aren't smart enough to use cpap machines...)

Totally untrue and inflammatory remark.
I'm not going to comment on personal experiences but I want to see if I can explain some respiratory risks in PACU and why CPAP usually does not address these problems. The respiratory depression/arrest that can occur has a neurological basis rather than obstructive. So while the effects of anesthesia and pain control narcotics are being balanced your apnea is usually not pressure related (obstructive) but neurological. So with most personal CPAP machines they do not respond unless you are breathing, meaning you may still be awakened by alarms and the nurse instructing you to take deep breathes. This stimulation is actually a part of your recovery. With cardiac monitoring, respiratory function monitoring, etc. in PACU, it will become evident whether you will be able to maintain respiratory functioning without assistance.

I understand surgery is scary, I've been there and don't like giving up control that general anesthesia requires. But in life I have come to understand that sometimes I have to turn it over because I can't fix it myself.
Now if you talk with your anesthesiologist and he agrees to provide CPAP in the PACU it may provide you comfort but probably will not address the main cause of the apnea until the effects of anesthesia have worn off.

Once you are transfered to your room and being allowed to sleep, CPAP may be very beneficial.

This is my understanding from my perspective and I'm not telling you where to take your stand. I don't pretend to have all the answers, just a few. I do wish you the best care and recovery for your surgeries.

49er wrote:OkyDoky,

I am really trying hear what you're saying but all the articles I have seen disagree with you, including this one:

http://www.outpatientsurgery.net/outpat ... ews--05-07

"We found that these patients wake up in PACU more fully awake than those who don't receive CPAP," says respiratory therapist Karl Ludwig, RRT, who adds that CPAP decreases carbon dioxide and helps patients wake up, while those without CPAP are more prone to a carbon dioxide-enhanced narcosis. "Patients we put in CPAP aren't falling back into that deep sleep mode after they get their pain meds because they're more awake after surgery."

This was referring to the fact that patients were put on the machine as soon as they arrived at the recovery room.

49er

This article is off topic since it is from a RT probably using a hospital machine which they have the ability to already do. I didn't say it wouldn't be beneficial. What I'm saying it is more problematic when you bring many different machines into the mix and most don't prevent the neurological apneas that you have to monitor for in the PACU.

Again.
This is my understanding from my perspective and I'm not telling you where to take your stand. I don't pretend to have all the answers, just a few. I do wish you the best care and recovery for your surgeries.

OkyDoky wrote:

49er wrote:OkyDoky,

I am really trying hear what you're saying but all the articles I have seen disagree with you, including this one:

http://www.outpatientsurgery.net/outpat ... ews--05-07

"We found that these patients wake up in PACU more fully awake than those who don't receive CPAP," says respiratory therapist Karl Ludwig, RRT, who adds that CPAP decreases carbon dioxide and helps patients wake up, while those without CPAP are more prone to a carbon dioxide-enhanced narcosis. "Patients we put in CPAP aren't falling back into that deep sleep mode after they get their pain meds because they're more awake after surgery."

This was referring to the fact that patients were put on the machine as soon as they arrived at the recovery room.

49er

This article is off topic since it is from a RT probably using a hospital machine which they have the ability to already do. I didn't say it wouldn't be beneficial. What I'm saying it is more problematic when you bring many different machines into the mix and most don't prevent the neurological apneas that you have to monitor for in the PACU.

Again.
This is my understanding from my perspective and I'm not telling you where to take your stand. I don't pretend to have all the answers, just a few. I do wish you the best care and recovery for your surgeries.

Are ASV machines any better at this? I'm curious, as that is what I use.

Darth Lady wrote:
Are ASV machines any better at this? I'm curious, as that is what I use.

I'm not familiar with all the different machines, but I do believe the ASV machines have a backup rate. This could be a benefit. You would need to discuss your specific needs and settings with your anesthesiologist.

49er wrote:
HI funky-rat,

I am so sorry for your horrific experiences. Why couldn't you take your oral meds with a sip of water on the day of surgery as people are instructed with most meds? Was there some reason you were given that you weren't allowed to?

49er

I don't regret having the surgery for a minute - even with my throat issues. Never underestimate the ability to breathe through your nose. It makes a huge difference in how I feel. I also love my ENT/Surgeon. I was just upset with the way my diabetes was handled, and that was mainly down to the anesthesiologist, and the problems he caused. He was teaching that day (I had students in with me) and maybe he wanted to show his power - who knows?

That being said....I was advised at my pre-op evaluation that they only wanted me to take my reflux meds that morning - I took my diabetes meds with supper the night before, and then they didn't want me taking them again because I wasn't going to be able to eat, and they were afraid that taking the meds without food would make my blood sugar go low, and I wouldn't be able to feel the low, and let them know about it (much like being sick and being diabetic). My GP was fuming over that, as was my diabetes educator. My blood sugar immediately before surgery was 200. I have a good A1C, and that's on record, so she said there was no reason for the anesthesiologist to demand an insulin shot before he'd sedate me, as it was likely due to the timing of my meds, and stress (I react badly to stress with my blood sugar). She said that it won't hurt to have blood sugar that high for a day or two (it happens all the time when diabetics get sick - flu, cold, etc), and that it's better to be high than low when you can't feel the lows. Plus, being type 2, it's even less of a concern if it's only going to be for a day or so, until the body adjusts. And lastly, that 200 isn't anywhere near 300/400, and the short-term damage that can cause. She told me next time, I am to tell them to operate, and if I'm still running high later, then perhaps they can use something to bring it down, provided they test me frequently.

funky-rat wrote:

49er wrote:
HI funky-rat,

I am so sorry for your horrific experiences. Why couldn't you take your oral meds with a sip of water on the day of surgery as people are instructed with most meds? Was there some reason you were given that you weren't allowed to?

49er

I don't regret having the surgery for a minute - even with my throat issues. Never underestimate the ability to breathe through your nose. It makes a huge difference in how I feel. I also love my ENT/Surgeon. I was just upset with the way my diabetes was handled, and that was mainly down to the anesthesiologist, and the problems he caused. He was teaching that day (I had students in with me) and maybe he wanted to show his power - who knows?

That being said....I was advised at my pre-op evaluation that they only wanted me to take my reflux meds that morning - I took my diabetes meds with supper the night before, and then they didn't want me taking them again because I wasn't going to be able to eat, and they were afraid that taking the meds without food would make my blood sugar go low, and I wouldn't be able to feel the low, and let them know about it (much like being sick and being diabetic). My GP was fuming over that, as was my diabetes educator. My blood sugar immediately before surgery was 200. I have a good A1C, and that's on record, so she said there was no reason for the anesthesiologist to demand an insulin shot before he'd sedate me, as it was likely due to the timing of my meds, and stress (I react badly to stress with my blood sugar). She said that it won't hurt to have blood sugar that high for a day or two (it happens all the time when diabetics get sick - flu, cold, etc), and that it's better to be high than low when you can't feel the lows. Plus, being type 2, it's even less of a concern if it's only going to be for a day or so, until the body adjusts. And lastly, that 200 isn't anywhere near 300/400, and the short-term damage that can cause. She told me next time, I am to tell them to operate, and if I'm still running high later, then perhaps they can use something to bring it down, provided they test me frequently.

Thanks FR, I learned something regarding the issues folks with diabetes face regarding anesthesia. Very informative, thanks.

As an FYI, according to revised anesthesia guidelines, you should be allowed to have toast and clear liquids 6 hours before surgery and clear liquids two hours before then. Unfortunately, many hospitals, including the one I will be having surgery at are still sticking to the NPO after midnight rule which angers me greatly because I feel that is putting my health at risk according to research. Another issue I am going to have to fight about.

And if you had been in Europe, you would have been given a carbohydrate loading drink to up to two hours before surgery. Sadly, not in the US.

Glad everything else turned out ok and hopefully, if god forbid in the future, you have to have surgery, you won't get such an AH anesthesiologist.

49er