Surgery and CPAP

[tvmangum]

On May 21, 2010, I am scheduled to have aortic valve replacement surgery at Duke University Medical Center. They have told me that I will need to bring my CPAP to the hospital.

What special considerations will they have to take when the put me to sleep? Will it be okay to use tap water in the tank for the week I'm in the hospital? I would just assume to not have to also drag purified water to the hospital to fill up the tank.

[guest2]

Call and ask the hospital directly, not your doctor because they may not know. When they put you to sleep their should be nothing different they will do other than to be aware of your situation and monitor you accordingly. As far as the water a week should not make a difference if you do not use distalled water just clean it when you are able. Also you might ask them if they will supply the distalled water but be sure to ask them what the cost would, 100.00 per ounce, 10.00 for an aspirin etc. But we do not need medical reform in this country.
Sorry I couldn't resist the opportunity to voice my opinion. But that being said good luck with your surgery and let us know how everything turns out.

[jnk]

On May 21, 2010, I am scheduled to have aortic valve replacement surgery at Duke University Medical Center. They have told me that I will need to bring my CPAP to the hospital.

What special considerations will they have to take when the put me to sleep? Will it be okay to use tap water in the tank for the week I'm in the hospital? I would just assume to not have to also drag purified water to the hospital to fill up the tank.

http://www.sleepapnea.org/resources/pub ... apuse.html

http://www.sleepapnea.org/resources/pubs/checklist.html

[brain_cloud]

What really would happen to someone with severe OSA immediately after surgery when the breathing tube is out, but the anesthesia effect is still strong? This must actually happen all the time, since many/most with OSA don't know about it, and so wouldn't have notified anyone about it. Or is it that when the application of general anesthesia is stopped, it only takes a few moments to get to the point where you could be aroused by an apnea?

Come to think of it, what happens when someone with severe OSA is knocked unconscious? Why don't they die?

[jnk]

What really would happen to someone with severe OSA immediately after surgery when the breathing tube is out, but the anesthesia effect is still strong? This must actually happen all the time, since many/most with OSA don't know about it, and so wouldn't have notified anyone about it. Or is it that when the application of general anesthesia is stopped, it only takes a few moments to get to the point where you could be aroused by an apnea?

Come to think of it, what happens when someone with severe OSA is knocked unconscious? Why don't they die?

Well, bottom line seems to be:

Evidence-based research on perioperative management of OSA patients is sorely lacking.

But these recommendations are interesting:

Recommendations from ASA guidelines:

Extubate only after patient is fully conscious and upper airway obstruction seems unlikely.

Supplemental oxygen use if desaturation occurs, but only for as long as necessary to maintain appropriate arterial oxygen
levels.

Continuous monitoring of oxygen saturation is necessary only in ICU or step down unit.

There is no consensus agreement on whether CPAP should be administered if there is evidence of apneas and desaturation or
if hypoxia persists with supplemental oxygen. This is especially controversial for patients who were not previously
treated with CPAP.

Consider use of nonopioid medications (such as NSAIDS) instead of or in conjunction with opioids to decrease the need
for analgesia. Use of regional analgesic techniques rather than systemic opioids can reduce the likelihood of adverse
respiratory events.

Avoid supine position for postoperative recovery. Consider placing at-risk patients in a sitting position to reduce OSA
episodes and improve oxygen saturation.

OSA patients without significant comorbid factors can be monitored in an ambulatory care postoperative unit with
proper nursing support and oxygen desaturation monitoring, but only if surgery is superficial or minor, and involves
local or regional anesthesia.

-- A Systemic Review of Obstructive Sleep Apnea and Its Implications for Anesthesiologists Sharon A. Chung, PhD; Hongbo Yuan, PhD; Frances Chung, FRCPC. A & A November 2008 vol. 107 no. 5 1543-1563 http://www.anesthesiaanalgesia.org/cont ... 3.full.pdf

Colorization mine.

jeff

[brain_cloud]

What really would happen to someone with severe OSA immediately after surgery when the breathing tube is out, but the anesthesia effect is still strong? This must actually happen all the time, since many/most with OSA don't know about it, and so wouldn't have notified anyone about it. Or is it that when the application of general anesthesia is stopped, it only takes a few moments to get to the point where you could be aroused by an apnea?

Come to think of it, what happens when someone with severe OSA is knocked unconscious? Why don't they die?

Well, bottom line seems to be:

Evidence-based research on perioperative management of OSA patients is sorely lacking.

But these recommendations are interesting: ...

jeff

Sure, but again, this has to be something that happens hundreds of times a day in surgeries where all involved are clueless, as it were. Are any deaths actually attributed to this scenario? How to find out for sure? I know, let's consult wikipedia.

[jnk]

You could do that.

Or . . .

"Extubate only after patient is fully conscious and upper airway obstruction seems unlikely."

[kteague]

The risks of OSA and benefits of CPAP support perioperatively seems to me to be a subject of developing knowledge. I remember a previous informative discussion on here, and that some research indicated that use of CPAP seemed to improve recovery. Last night I was doing some reading over on PubMed. Unfortunately, I fell asleep in the middle of multiple links and quotes, so this time around I'll just suggest the site.

I would think that particularly with cardiac surgery, removing (by CPAP use) the factors of increased heart rate and blood pressure that can accompany apnea events would be a good thing. Your cardiologist and anesthesiologist are probably in tune with all this. A friend of my son-in-law had valve surgery last year, but I don't know which valve. The hardest part for him was curbing activity afterward.

When you feel up to it, let us know how you are doing - and if they put your CPAP on you or not. Best wishes on a successful surgery and speedy recovery.

Kathy

[jnk]

The risks of OSA and benefits of CPAP support perioperatively seems to me to be a subject of developing knowledge. I remember a previous informative discussion on here, and that some research indicated that use of CPAP seemed to improve recovery. Last night I was doing some reading over on PubMed. Unfortunately, I fell asleep in the middle of multiple links and quotes, so this time around I'll just suggest the site.

I would think that particularly with cardiac surgery, removing (by CPAP use) the factors of increased heart rate and blood pressure that can accompany apnea events would be a good thing. Your cardiologist and anesthesiologist are probably in tune with all this. A friend of my son-in-law had valve surgery last year, but I don't know which valve. The hardest part for him was curbing activity afterward.

When you feel up to it, let us know how you are doing - and if they put your CPAP on you or not. Best wishes on a successful surgery and speedy recovery.

Kathy

Yes, I remember reading somewhere that in some places they have put everyone on 10 cm nasal CPAP as a matter of course after some cardiac surgeries, including those people who do not have OSA. But I don't remember where I read that, either.