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How One Hospital Treats Sleep Disordered Breathing Patients for Surgery (by flyg (CPAP Safety)
The following posting was written in response to a thread ( http://www.cpaptalk.com/viewtopic.php?t=18783 ) about this article: http://www.knoxnews.com/kns/local_news/article/0,1406,KNS_347_5462170,00.html Posted: Wed Apr 18, 2007 11:03 pm Post subject: [Note: from the "This Is Serious" Thread] Hi all.....very sad article indeed. Let me see if I can clear up a few things after reading many of your responses and concerns. I am a fellow CPAPer and also a recovery room nurse. I deal with OSA patients everyday. I'll and tell you how we deal with patients with a history of sleep apnea or have certain risk factors which make them more at risk after having anesthesia and then narcotics for pain relief. Our hospital has instituted a prescreening questionaire which all patients fill out so we can predetermine who already has a diagnosis of OSA and then which of the other patients may have certain conditions which put them at risk (ie:treated for high blood pressure, snoring, known apnic spells, or overweight) This way we have some advance notice about these patients. Anesthsiologists also somtimes pick up certain indicators by their interviews with patients preoperatively. First, yes its very important to make all your doctors aware of your OSA history, and esp. your anesthesiologist. We have you bring your mask with you to the hospital and then will treat you with CPAP, APAP, or BIPAP while in the hospital esp. at night while sleeping. If you have a general anesthesia (put totally out with a breathing tube down your throat during surgery), you will actually be on a ventilator type of machine during the surgery (thats what the anesthesia machine does) It administers certain anesthetic gases, as well as gives you ventilatory support while you are anesthetized. Now after the tube is out and you are in recovery waking up you will be on various monitors including B/P, oxygen saturation monitor and heart monitor. We unitlize all of these as well as close physical monitoring to assure you are breathing well while you wake up. But another critical part of my job is to also control your pain from the surgery....we do this by giving narcotics (like in the article) We closely monitor all patients, but use special caution in our OSA patients. We then assess how the patients have responded and collaborate with anesthesia and the surgeon on deciding if the patient need continued close monitoring in our intermediate care unit (like an ICU step down unit) or maybe they are doing well enough to go to a regular post-op unit, but we then send them with central telemetry monitoring with oxygen saturation monitoring as well. Had the patient in the article had this type of monitoring post op, the fatality possibly could have been avoided. Where I see the problem laid in the woman in the article, was not only a lack of communication between the surgeon and anesthesia, but also no special monitoring was done on the floor while the patient was in that first critical 24hr period when you are still blowing off anesthesia gases and then also on narcotics. Many of our OSA patients get pain pumps to use for pain control after surgery, but then we also use these additional monitors for their safety while on these pumps ..Our patients will use cpap regardless what unit they end up on....to continue to receive good oxygen and positive pressure we all need when we have this diagnosis of OSA. I recommend to anyone going into the hospital to always take their CPAP gear with them and let everyone know what their history involves so the medical people taking care of us can better do this with all the facts. Hope this explains a few things and answers some questions. Carol _________________
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How One Hospital Treats Sleep Disordered Breathing Patients for Surgery (by flyg (CPAP Safety)

The following posting was written in response to a thread ( http://www.cpaptalk.com/viewtopic.php?t=18783 ) about this article: http://www.knoxnews.com/kns/local_news/article/0,1406,KNS_347_5462170,00.html

Posted: Wed Apr 18, 2007 11:03 pm Post subject: [Note: from the "This Is Serious" Thread]

Hi all.....very sad article indeed. Let me see if I can clear up a few things after reading many of your responses and concerns. I am a fellow CPAPer and also a recovery room nurse. I deal with OSA patients everyday. I'll and tell you how we deal with patients with a history of sleep apnea or have certain risk factors which make them more at risk after having anesthesia and then narcotics for pain relief.

Our hospital has instituted a prescreening questionaire which all patients fill out so we can predetermine who already has a diagnosis of OSA and then which of the other patients may have certain conditions which put them at risk (ie:treated for high blood pressure, snoring, known apnic spells, or overweight) This way we have some advance notice about these patients. Anesthsiologists also somtimes pick up certain indicators by their interviews with patients preoperatively. First, yes its very important to make all your doctors aware of your OSA history, and esp. your anesthesiologist. We have you bring your mask with you to the hospital and then will treat you with CPAP, APAP, or BIPAP while in the hospital esp. at night while sleeping.

If you have a general anesthesia (put totally out with a breathing tube down your throat during surgery), you will actually be on a ventilator type of machine during the surgery (thats what the anesthesia machine does) It administers certain anesthetic gases, as well as gives you ventilatory support while you are anesthetized.

Now after the tube is out and you are in recovery waking up you will be on various monitors including B/P, oxygen saturation monitor and heart monitor. We unitlize all of these as well as close physical monitoring to assure you are breathing well while you wake up. But another critical part of my job is to also control your pain from the surgery....we do this by giving narcotics (like in the article) We closely monitor all patients, but use special caution in our OSA patients. We then assess how the patients have responded and collaborate with anesthesia and the surgeon on deciding if the patient need continued close monitoring in our intermediate care unit (like an ICU step down unit) or maybe they are doing well enough to go to a regular post-op unit, but we then send them with central telemetry monitoring with oxygen saturation monitoring as well.

Had the patient in the article had this type of monitoring post op, the fatality possibly could have been avoided. Where I see the problem laid in the woman in the article, was not only a lack of communication between the surgeon and anesthesia, but also no special monitoring was done on the floor while the patient was in that first critical 24hr period when you are still blowing off anesthesia gases and then also on narcotics.

Many of our OSA patients get pain pumps to use for pain control after surgery, but then we also use these additional monitors for their safety while on these pumps ..Our patients will use cpap regardless what unit they end up on....to continue to receive good oxygen and positive pressure we all need when we have this diagnosis of OSA.

I recommend to anyone going into the hospital to always take their CPAP gear with them and let everyone know what their history involves so the medical people taking care of us can better do this with all the facts.

Hope this explains a few things and answers some questions.
Carol

_________________

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