What level of anesthesia do we have to worry about?

pjwalman · Post by **pjwalman** » Fri Jun 27, 2008 5:28 pm

I have the "pleasure" of going in for an endoscopy and colonoscopy in a couple weeks, and I wonder if that level of anesthesia, which I understand is fairly light, is something I need to worry about in Recovery. I've read of others being concerned about anesthesia and wondering if the nursing staff will pay enough attention while in Recovery, but for those types of procedures, is it light enough that I don't have to worry too much?

Thanks!

Peggy

Slinky · Post by **Slinky** » Fri Jun 27, 2008 6:39 pm

Usually, Versed and Demerol or Fentanyl in place of the Demerol are used for the "conscious sedation" for both upper and lower scopes. If you are having both done the same day they will need to sedate a little heavier than if you were having one or the other done alone. However, a short acting anesthetic is becoming more popular, Diprivan (propofol).

It is best if you take your CPAP and mask w/you. Its also best if you notify your gastro and the endoscopy unit well before your procedure that you do have OSA and are on CPAP for sleep. Regardless of what they say, take your CPAP and mask w/you. Remind each staff person you encounter that you have OSA, that you have your CPAP and mask w/you and insist that one of the staff watch you show them how to use put the mask on you and turn the CPAP on.

Most likely you will have no problem. I have both COPD and OSA. I did take my CPAP and mask w/me. One of the staff asked me how to use it. But I never needed it. However, I was also having just the colonoscopy.

Just in case, too, you should insist that a member of your family or designated driver be brought to your recovery cubicle or room IMMEDIATELY when you are returned there for recovery or even before. The staff are in and out checking your vitals - but the times they are out are when your family member or driver becomes important. The staff should also NOT remove your monitoring equipment until you are fully awake and ready to be discharged. Your family member should be someone not afraid to speak up if needed.

Once home you may well still be sleepy and its a good time to sleep off the residue from your procedure. BE SURE TO DON YOUR CPAP AND MASK. Its always better to be safe than sorry.

pjwalman · Post by **pjwalman** » Fri Jun 27, 2008 6:57 pm

Thank you, Slinky! I appreciate it. I did tell the doctor I had concerns, and she reassured me that they would pay close attention during the procedures and stop if anything seemed untoward, but I am more worried about the recovery time when I know hospital staff will likely just be flitting in and out. So I could insist that my husband be there to watch me as soon as I got to Recovery without violating hospital regs? And I wondered if I should try to get a medical alert bracelet about having sleep apnea before I go in, but I think they make you take off all your jewelry anyway, so that would probably be a pointless rush to get it in time. Do many people actually wear those do you think? I've been thinking maybe I am just being dramatic to think I need one, but I do have severe OSA when off the CPAP, so I don't want to dismiss it without at least thinking carefully about it.

Peggy

yorkiemum01 · Post by **yorkiemum01** » Fri Jun 27, 2008 7:25 pm

As someone from the Gastroenterology field 16 yrs ....exactly what Slinky said. Educate, educate, educate...those who will render your care.
The sedation is in IV form, and you should wake quickly, but will more than like be a bit drowsy for a bit afterwards. The prep is far tougher
than the procedure itself, so consider the hardest part behind you upon arrival at the center. Certainly do want to stress how IMPORTANT this test
is to everyone, as undetected colon cancer can be a killer.
Good work Slinky, you've done your homework.

Slinky · Post by **Slinky** » Fri Jun 27, 2008 7:37 pm

Thanks, YorkieMom. I also have Crohn's disease so am a scope veteran. Tho have only had one upper and one lower since starting on xPAP. You and I HAVE to chat sometime!!!!

Yup, PJ, you've got the timing right, the recovery room is where you're at the most risk. I've had scopes at two hospital endoscopy units and one stand alone clinic and they all allow family in the recovery room so I would guess yours will too. But ask and if necessary insist, just in case. Practices vary from unit to unit.

I've never bothered to get a medical alert bracelet but its not all that bad an idea. Especially if one has severe OSA. I'm always gonna ... but I'm the world's best procrastinator - I'll be holding the door open for all my friends.

greyhound · Post by **greyhound** » Fri Jun 27, 2008 8:04 pm

Just make sure the anesthesiologist knows that you have sleep apnea. It will affect the anesthesia that they give to you. My wife (no sleep apnea) definitely had a "lighter" anesthesia than I did, even though we had our colonoscopies in the same hospital and used the same GI doctor.

ozij · Post by **ozij** » Fri Jun 27, 2008 9:29 pm

I had a colonoscopy two years ago.

I made sure they knew of my sleep apnea ahead of time. Asked to meet ther nurse who would be responsible for the recovery room on the day of my procedure - and had that meeting a few day before the procedure. Made sure there was an electricity outlet I could connect to, explained I would like to hava a friend come along to put the cpap on me (no problem). Since I first came at a time that was convenient for the staff my request was not an unexpected interruption in their routine, and they were intrested in what the machine was, etc. On the day of the pocedure, I did not expect them to remember me - but I did expect them to recall when I mentioned it.

I did use the cpap during the procedure - not an optoion of course when they're doing an endoscopy. 5 mg. intravenous Versed had me knocked out entirely.

Good luck.

O.

alnhwrd · Post by **alnhwrd** » Fri Jun 27, 2008 10:27 pm

The next time I have to go in the hospital for any procedures, I am going to write, "I HAVE SLEEP APNEA, NEED CPAP" across my forehead. Of course, those who do not have a monstrously large teutonic head with a swiftly receding hairline like me would not have room for this, but an abbreviated version would do the trick

birdshell · Post by **birdshell** » Fri Jun 27, 2008 11:21 pm

Unfortunately, I have had a number of surgeries and procedures. Anesthesiologists have assured me that they always check for any signs of apnea, but that doesn't mean that I EVER "forget" to tell them.

I have two bleeding disorders that are not as commonly known, although the major one is the MOST COMMON of all the bleeding disorders. I have to do educating almost every time I have something done in a hospital. I have had blood tests and bleeding times done, which tell no one anything about my bleeding disorders. Many bleeding disorders will vary from day to day in severity.

So, as a result of those and my allergies, I always wear a Medic Alert necklace or bracelet. I cannot recall if I wore the necklace for my colonoscopy, but any time I do remove a Medic Alert tag, I notify someone whom I trust about the reason for wearing it, and where it is located in case of an emergency.

Please note that the Medic Alert Foundation was started by a doctor whose daughter nearly died from an allergic reaction while he was out of town. The Medic Alert Foundation has kept up with technology; and they never remove your record if you do not pay their fee; they just limit your ability to change the record.

Just getting a tag at the pharmacy, or jewelry store, does not provide the wealth of information that one might be wise to share in an emergency. If I am unable to speak for myself, I trust that my Medic Alert tag and the entire Medic Alert system will speak for me.

Karen,
Who sincerely hopes CPAP users will wear a tag in case of emergency.

lcook7281 · Post by **lcook7281** » Sat Jun 28, 2008 7:23 am

I fully agree about the medic alert. I have been wearing my bracelet for about 5 years now. I started when my mother had a procedure and temporarily lost most of her memory. Why I waited so long I am not sure because she lived in a different state and we rarely see each other.

I had not been diagnoised with UARS until last year so I just add a new inforation to my file as necessary.

The other nice feature about medic alert is you are able to update your medications on file. Usually I am lazy and just call them and have them do the work. If you react to something bizarre and it is not in the system--they get it there for you (i.e. allergic to disolving stitches).

Also you are able to print copies of your medications. This has come in handy when I see a new doctor and forget to write the list down. I just get on the computer and print them a copy of my medic alert information. I manage to get my allergies all listed at the same time. Saves the office and me a lot of time.

Lisa

tnmom · Post by **tnmom** » Sat Jun 28, 2008 8:48 am

I had a "conscious sedation" catheterization a few weeks ago, and I agree, the recovery room is the problem. I think I was so uptight about it I wasn't all that sedated. There were men on either side of me in the recovery room, and I could have diagnosed the apnea SO easily. They were snoring loudly, choking and gasping, immediately after having angioplasty and/or stents put in their hearts!!! apparently the nurses weren't all that concerned, but it just goes to show that we all have to be adamant about our own conditions, and recruit someone else to be right there being your advocate when you are unable to do so.

Slinky · Post by **Slinky** » Sat Jun 28, 2008 9:02 am

Wow! That is scarey about those poor men, TNMom!! Thanks for so graphically warning that we can NOT rely on hospital staff whilst in the Recovery room!!!

crazyrede · Post by **crazyrede** » Sat Jun 28, 2008 9:34 pm

In the hospital unit that I work in (Open heart Unit and step down) we plaster "sleep apnea" across the front cover of the patient's chart. You can require that the admitting nurse does the same for you. All they need is a peice of white tape and a sharpie marker. That is in addition to your consistent explanation of your condition(s)

Regarding having someone come into recovery immediately upon your arrival after the procedure - don't take no for an answer. In fact, I am learning to write anything out of the ordinary, such as this request, above my signature on the treatment consents that I sign in the doctor's office and at the facility. That way, there is NO question about what my expectations are. Have the doctor and nurse initial the additional condition on the respective consents BEFORE the procedure.

My son recently had cervical surgery. The hospital that we chose to have the surgery has a "policy" that I was not aware of prior to his stay. On this particular floor post-surgery (critical care - but not icu), family may not remain with the patient after 8pm unless the patient is under 18, a non-english speaker, or dying (my son is in early 20s). As the parent and payor of the hospital bill I did not take "no" for an answer (very calm, with a smile, I kept telling the staff - up the supervisor line - the medical reasons why I was staying; and, I did not move). My critical care surgical floor regularly has family stay with the patient as long as there is no interference with the patient's care.

No one will volunteer to advocate for you. Educate a family member or friend to help you here. And, open your mouth about your needs.

Mask

Additional Comments: CMS 50-F Pulse Oximeter