Question about OSA and surgery/anesthesia

MrRandom · Post by **MrRandom** » Tue Apr 22, 2008 10:53 am

If I still have apneas even when using the CPAP, will I end up in ICU with breathing machine after surgery? It seems to me that it would only take one event, am I right? If I can't wake up because of lingering effects of anesthesia and/or effects of any pain drugs? This surgery is one of the reasons the doctor wanted me to set a range. But even on the range I was still having some events. Can any of you give me your experiences with anesthesia and using the CPAP?

NightHawkeye · Post by **NightHawkeye** » Tue Apr 22, 2008 11:05 am

You are correct, MrRandom. You need to not only take your CPAP with you, you need to have someone you trust with you at all times, from the moment you are taken out of the operating room. It is the post-operative period when OSA patients are at high risk of death - from suffocation. Hospital staff will not be able to stay with you constantly during recovery, regardless of however good their intentions may be.

Here's a link to one good discussion on the topic.
viewtopic.php?t=7865&postdays=0&postorder=asc&start=0

Regards,
Bill

cflame1 · Post by **cflame1** » Tue Apr 22, 2008 11:11 am

I discussed my treatment with the anesthesiologist prior to the surgery and even though I brought the machine with me in order to be able to use it in the recovery room, it was never used.

I was actually awake until I got on to the table... shortly after that I was out like a light. They woke me up while I was still on the operating table after the surgery and helped me into a chair... I was in a chair until my friend came to take me home.

NightHawkeye · Post by **NightHawkeye** » Tue Apr 22, 2008 11:17 am

cflame1 wrote:I was actually awake until I got on to the table... shortly after that I was out like a light. They woke me up while I was still on the operating table after the surgery and helped me into a chair... I was in a chair until my friend came to take me home.

Sounds like you had an excellent anesthesiologist, cflame1.

MrRandom · Post by **MrRandom** » Tue Apr 22, 2008 11:23 am

A family member will be with me at the hospital so I guess he will be allowed into the recovery area with me? What can he do if I stop breathing and don't recover? Get the nurse? Coz the machine has to be turned off and back on again to set the pressure higher.

I did ask if I could talk to the anesthesiologist prior to surgery, but the surgeon said they use a rotating group of anesthesiologists and wouldn't know which one I'd get til the day of surgery. I'm sure I'll see him/her right before surgery though, right? The surgeon is supposed to be making a note in my file about the apnea, I hope that helps. I believe there are different ways to do anesthesia and some of the drugs are shorter acting. Perhaps that what they did for you cflame1.

NightHawkeye · Post by **NightHawkeye** » Tue Apr 22, 2008 11:38 am

MrRandom wrote:A family member will be with me at the hospital so I guess he will be allowed into the recovery area with me? What can he do if I stop breathing and don't recover? Get the nurse? Coz the machine has to be turned off and back on again to set the pressure higher.

You shouldn't need increased pressure. Hopefully, you'll just be groggy by that time. Whoever's with you needs to make sure that your mask stays on and that you are continuing to breathe. If need be, get the nurse.

MrRandom wrote:I did ask if I could talk to the anesthesiologist prior to surgery, but the surgeon said they use a rotating group of anesthesiologists and wouldn't know which one I'd get til the day of surgery. I'm sure I'll see him/her right before surgery though, right? The surgeon is supposed to be making a note in my file about the apnea, I hope that helps. I believe there are different ways to do anesthesia and some of the drugs are shorter acting. Perhaps that what they did for you cflame1.

The answer you got from your physician wouldn't inspire confidence in me. Maybe if you explained that OSA kills people after surgery, and that you have a particular interest in staying alive, maybe he'd see things a little differently.

Seriously, though, the last couple of surgeries I had, I specifically asked for minimal anesthesia. I was also awakened before being taken from the operating room.

Regards,
Bill

MrRandom · Post by **MrRandom** » Tue Apr 22, 2008 11:45 am

I did send him the link to that page about OSA and anesthesia, he just said the hospital is a good one and won't let me die. I don't think he really understands OSA to be honest, but I really want him to do my surgery because he's good at that part of it. Not sure what else I can do except bring the CPAP and make sure to tell everyone about it, that I want minimal anesthesia etc.

NightHawkeye · Post by **NightHawkeye** » Tue Apr 22, 2008 11:51 am

MrRandom wrote: ... the hospital is a good one and won't let me die.

Uh, huh ..., well, sounds like you're planning to take all prudent precautions. I hope the surgery goes well for you.

Regards,
Bill

Slinky · Post by **Slinky** » Tue Apr 22, 2008 12:13 pm

More and more hospitals are contracting out their anesthesia to anesthesiologist groups and have no say in the anesthesiologists' rotation. Which means the patient doesn't get to see the anesthesiologist until JUST before surgery. Our hospital just did the same thing w/both anesthesiologists and radiologists. Its a crap shoot which one you get for either procedure. A lot of "our" surgeons don't like it as they have one or two anesthesiologists they like working w/moreso than others.

"I" don't like it because between Crohn's disease, COPD and a post menopausal simple ovarian cyst I've gone thru a LOT of radiology procedures and have gotten to know which are the better radiologists for which type of procedure and I can no longer schedule a procedure w/a specific radiologist. "We" lost our BEST special procedure radiologist because he refused to sub-contract w/the hospital via this radiologist group. His wife is an excellent pulmonologist and we lost her too as they opted to go elsewhere and moved to another area. I won't even consider having surgery locally. Mayo Clinic, Rochester, MN, is only a 12 hour drive from here.

Patients now get all this great advice about talking to their anesthesiologist at their pre-surgical consult, etc. right at the time hospitals are resorting to this contracting out of anesthesiology services. What a crock of horsepuckies!! Its a cost-cutting measure that has NO BENEFIT to the patient at all.

Take your CPAP and equipment w/you. Also take a strong-willed patient advocate w/you. One who won't be cowed or intimidated by the nurses and/or doctors. Be sure to advise EVERYONE on the hosptial staff that you encounter about your OSA and that your CPAP equipment is there w/you. Check w/the hospital ahead of time, some want you to bring it in for a check w/the medical device personnel before allowing its use.

Mile High Sleeper · Post by **Mile High Sleeper** » Tue Apr 22, 2008 12:14 pm

MrRandom, the problem usually isn't with the surgery, it's with the recovery. The anesthesiologist will keep you breathing. After surgery, in recovery, you need CPAP. If possible before the surgery, meet with the recovery nurse/staff and make sure they know you need CPAP. Is your CPAP machine cleared with the hospital for use? Will they know where it is? They should be able to tell you those things before surgery to ease your mind.

Good luck and happy recovery.

xyz · Post by **xyz** » Tue Apr 22, 2008 12:47 pm

> You need to not only take your CPAP with you, you need to have someone you trust with you at all times, from the moment you are taken out of the operating room.

I agree in principle (that's the way it should be), but in practice it's not always possible.

One of our local hospitals now forbids patients from bringing their own equipment. You have to depend on them to have the right equipment and to set it up right. I don't have complete confidence that everything will be exactly right.

The recovery room (post-op) is generally treated as off limits for "visitors" (non-patients) until it's time to pick up the patient.

Everything is set up for the convenience of the hospital. CYA is the policy.

Insist on speaking with the anesthesiologist before they wheel you into the operating room. See if, before you go into the pre-op room, you can go to the post-op room and speak with them about your xpap needs. Give them all the details.

NightHawkeye · Post by **NightHawkeye** » Tue Apr 22, 2008 1:14 pm

xyz wrote:One of our local hospitals now forbids patients from bringing their own equipment. You have to depend on them to have the right equipment and to set it up right. I don't have complete confidence that everything will be exactly right.

The recovery room (post-op) is generally treated as off limits for "visitors" (non-patients) until it's time to pick up the patient.

I have great difficulty believing all that. I've never experienced any of that personally, and I've been involved with a number of surgeries (fortunately, most not my own). In my experience, "visitors" are allowed in recovery for a good reason. Of course, maybe my experience just involved medical personnel willing to look the other way.

If I ever experience any of that though, my already low opinion of the medical profession will drop a notch further down.

Regards,
Bill

Guest · Post by **Guest** » Tue Apr 22, 2008 2:05 pm

Hi MrRandom, I have double septum surgery with double turbinate reduction in Nov. 2007 and did just fine without the cpap machine, my surgery took about 1 hour tops, I don't know what kind of surgery you are having or how long it will take... But, the shorter time your OUT, the better.

Rooster, a member on this forum had the same surgery as I did and he took his cpap to the hospital with him along with a full face mask the covers the whole face, the nurses hooked him up to it after surgery and had to chuckle at the mask , he did wonderful so maybe that's something to think about!

Maybe someone can direct you to " ROOSTER's Septum Surgery " thread, like RestedGal, she's good at that

Goodluck,

SleepyNoMore

Slinky · Post by **Slinky** » Tue Apr 22, 2008 4:23 pm

NightHawkEye, that's not the first time I've read of someone not being allowed to bring their own CPAP equipment and having no choice but to rely on the hospital's staff and equipment. Scarey as h*ll but it evidently is still the policy in some hospitals.

roster · Post by **roster** » Tue Apr 22, 2008 4:47 pm

Anonymous wrote:.......
Rooster, a member on this forum had the same surgery as I did and he took his cpap to the hospital with him along with a full face mask the covers the whole face, the nurses hooked him up to it after surgery and had to chuckle at the mask , he did wonderful so maybe that's something to think about!

..........

I have had two surgeries and took my cpap equipment to both. First was a surgery to shorten a metatarsal and they used an ankle block and a sedative that put me in a deep sleep. Second was a Double Septoplasty and Bilateral Submucosa Resectioning of the Turbinates. The used general anesthesia for this.

They never used the cpap on me. The recovery room personnel for the orhopedic surgery said they kept me breathing by sitting me up and jostling me as soon as I stopped breathing. For the nasal airway surgery, the recovery room personnel said I never stopped breathing. I don't know how that was because I was out on my back for an hour. But I don't think I had apneas because I felt good after I recovered.

The link guest is referring to is viewtopic.php?t=26228&postdays=0&postorder=asc&start=0.

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