General Anesthesia and CPAP

[roster]

I will have a pretty difficult foot surgery later this month. The top-notch foot surgeon I will be using did not know crap about cpap or sleep apnea. When I pressed him on this issue he said maybe the anesthiologist would do an ankle block instead of general anesthesia. He also said in any case I would be surrounded by people who will know what to do about apnea.

Later I received a call from the operating room to get a little history and give me instructions for the surgery. One of their standard questions is do you have sleep apnea and are you a cpap patient. They told me to make sure I bring my cpap equipment to the surgery. That was reassuring.

I believe they will use general anesthesia. What should I expect? Will I be able to put on my mask or will the operating room personnel have to do it? I am using the Hybrid mask and am concerned that they might screw up the adjustments on the mask headgear.

[blarg]

I'm pretty sure that if you say, "NO, LEMME ADJUST IT" they'll be fine with that. I'm assuming they have a way of slipping any laughing gas they want to use into your CPAP air, in which case they'll want it sealed properly anyway. I don't see why they wouldn't let you put it on yourself.

[bdp522]

Do you have a different mask to use just for the surgery? I don't think I'd trust them with my hybrid either!

Brenda

[trelane]

I had knee surgery, and when the anthesthesiologst found out I depend on a CPAP, he gave me a spinal.

[Elle]

I was told to bring cpap for post surgery. During surgery you are usually intubated but in the recovery room you need your machine because your relfex to start breathing again is not as strong after the anaesthetic. thats the scoop I was given. Also, sometimes when you are just having a day surgery they will keep you overnight or at least a lot longer in the recovery room because you will be drowsy for hours.

[Sleepless_in_LM]

For what it is worth, I have been through two surgeries this fall. Both used gerneral anesthesia. Both times they had me bring my equipment, but I did not use it till I went to sleep at night. During surgery they will not use it because they have a breathing tube in to make you breathe. Both times they wanted it in recovery in case they needed it, but both times they did not. My first recovery nurse told me I was having some apneas but my O2 levels didn't drop far enough to require the cpap. I was put on O2 and kept on a pulse oximeter for my entire stay at both hospitals.

I found the nursing staffs pretty familiar with OSA. Even had one nurse who had OSA herself and took special interest in my Hybrid. But at both hospitals, they had respiratory come up to setup my cpap and both screwed it up. Those "professionals" were useless. The first filled the humidifier right to the top and caused some serious rainout and breathing difficulties. At the second hospital, the guy only filled my humidifier half to the "line" and looked at the cord coming out of the humidifier and didn't know what to do with it (remstar) and just left it hanging there. I just waited for him to leave and set it up myself.

For the most part, it was no big deal, but it was nice to have the CPAP to sleep at night.

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[OSAGuy]

I have had two surgeries over the past year, both using general anesthesia and unfortunately both on my Achilles. The real issue is not the use of the CPAP during surgery, as the Anestheologist handled that for me. It's the time in the recovery room where it may be needed. During my visit with the Anestheologist prior to the surgery he said that I wouldn't need the CPAP during surgery, as he knows how to handle it. My orthopedic surgeon was also aware of my sleep apnea but was very specific that I also needed to visit with the Anesthesologist about it to assure myself about how it would be handled. I discovered that while the orthopedic doc was aware of imy sleep apnea and familiar with the issues with it, his job in the OR was to deal with the reconstruction of my achilles and that the Anehstheologist would handle the breathing. Has a nice reassuring talk with the Anestheologist prior to the surgery and had no isssues. The nurses took care of the use of the CPAP in recovery.

Had no issues during surgery or in recovery. I did have problems after the surgery, as I was on some very strong pain medication for a ten days after. I discovered both times that I had a difficult time getting a good night's rest due to the effect of the pain medication. However, once I got off the Hydorcodone the problem went away.

Best of luck on your surgery.

[Snoredog]

I've been under several times since going on cpap, no big deal, I made sure I put OSA down on my medical history, then I made sure to personally told the anesthesiologst to "keep my airway open" before he stuck anything in my arm.

He did and it wasn't a problem, I didn't need cpap afterward either.

[billbolton]

See the post on CPAP and anethesia under the CPAP Saftey, Warning & Pitfalls section in the "Our Collective Wisdom" (aka Yellow Light Blulb) area here on CPAPtalk.

Cheers,

Bill

[Vader]

I was told to bring cpap for post surgery. During surgery you are usually intubated but in the recovery room you need your machine because your relfex to start breathing again is not as strong after the anaesthetic.

That is correct.

The anesthesia Doctor will be making sure that your airway is open during your procedure, but NO they WILL NOT be using any of your CPAP equipment during the procedure. After surgery, you may use your cpap in the recovery room, or in your extended stay room , should you require to be there overnight.

[yardbird]

I've had several surgeries on my lower leg since my accident. I can confirm that teh anesthesiologist takes care of keeping the airway open. I also broke my neck several years ago and because teh cervical spine is fused, I asked NOT to be intubated. (I can't position my head the way they need to.... head back, chin up kinda position). That request was also respected. Kinda like... in an emergency, do what ya gotta, but I would LIKE to not be intubated. Made them aware of OSA, they watched it, but didn't use cpap in recovery either.

We're all different. Just make sure you tell your surgical team about your OSA and believe me they will make sure you're ok. If you are not confident that will will ensure that you keep breathing, then it's time to get a new surgical team

[WillSucceed]

I had surgery on a lower extremity last year. After talking with a couple of the anesthesiologists that I work with, I opted to have a spinal block instead of a general.
A general is hard on your body and lengthens your hospital stay. The spinal was no big deal at all, I felt absolutely zero pain and was out of hospital on the same day that I went in for the surgery.
As some of the other posters have noted, during surgery with a general, you are intubated and the doctor controls your breathing with a machine. The problem regarding apnea occurs once you are extubated but still very drowsy from the general. You may be too drowsy to get your mask on/set-up the machine and the staff are likely to have zero experience with your particular machine.
If you had a spinal, your brain is not affected, neither is your level of wakefullness (unless they gave you some additional sedation) and you would be able to manage your machine and mask on your own, in the event that you wanted to nap before d/c from the recovery room.
The other factor that really swayed me toward selecting a spinal instead of a general is that the risk factors, overall, are WAY lower with a spinal than they are with a general.
Good luck!

[Snoozing Gonzo]

I had knee surgery with a general anesthetic a little over a week ago and had the same concerns. I was asked to bring the CPAP by the surgery center at pre-op. As mentioned several times above and by the anesthesiologist prior to the surgery, my throat was kept clear during surgery. I was told that the CPAP would be ready but it was unlikely that I would be out for very long and would be constantly monitored in recovery and that they would have me in a slightly reclined sitting position. I guess all that worked as I never had the CPAP on.

My main problem with the whole thing was not the folks that didn't know anything about CPAP but those who thought they did. For example, the pre-op nurse saying to bring Swift instead of Activa because would be easier for a nurse to strap on me and sealed... wrong! - I brought the Activa. Another example is a nurse that said she could hook up the CPAP if it was needed. I put on the plugs, mask, hose, and water in the humidifier, placed it back in the bag ready to plug into the wall and go.

All in all it was not a big deal.

Good Luck!

Chris

[lvwildcat]

Another tip from an RN in a BIG,BUSY hospital-make sure that all of your equipment is clearly tagged and marked with your name. That way if unfortunately it's misplaced it can easily be identified as yours

[krousseau]

Have knee surgery scheduled Jan 4. See the hospital pre-op nurse Dec 21 to go over all labs, EKG, CPAP.

My plan;
1) label equipment clearly
2) get a separate passover humidifier to avoid someone picking up the integrated unit and sloshing water into the blower
3) print out signs to put on CPAP
4) take copies of prescription
5) print out warnings re sleep apnea for my chart
6) take the instruction book

A spinal is planned-but there is a very slim chance it won't take-and they would have to "put me out" and I would need CPAP in recovery room

The good thing-I have a good friend who works in the hospital and can assure communications get passed on-find out if the staff is familiar with CPAP etc.