Having Anaesthetic and Sleep Apnea

[mars]

Hi All

Sometime in July I will be having a Gastroscopy and biopsies to check out my Barretts Esophagus. It is inflamed, and the last biopsies were indeterminate.

I usually have the gastroscopy without anaesthetic, as I like to drive home straight afterwards. However, this time I will have to have an anaesthetic because I must be absolutely still so they can get the right areas for the biopsies. And this will be the first time I will be anaesthetised since I have learned about my sleep apnea.

I did a search and found a thread dated 2005, which was very helpful. However, 4 years have passed and I wonder if there is anything new I need to know, or insist upon when I go to hospital.

I am thinking that I should tell them to lie me on my side, and attach my machine to me right after the gastroscopy. Given the lack of knowledge about sleep apnea in the medical profession I must admit I was a little concerned, but I was cheered by the Theatre Admittance making an appointment for me with the anaesthetist before the procedure. And I have to take my machine along.

Any thoughts or suggestions?

cheers

Mars

[Slinky]

Since you have the appointment w/the anesthesiologist prior to your gastroscopy and have been told to bring your CPAP to that appointment I would just be sure to have a family member w/me who is bold enough to insist on being present w/you in recovery and that your CPAP has been properly put on you and turned on or that the family member be the one to put your mask on you and turn your CPAP on and that you are kept on your CPAP until you are ready for release.

[JayR_1945]

Good advice and also good that you are talking to your anesthesiologist before hand.

CNS depressants (anesthtics) reduce the threshold at which the neuoro system detects hypoxia.
So, (undiagnosed) Sleep Apnea patients are more likely to go into respiratory arrest, and may need mechanical ventilation. The fact that you and your Anesthesiologist are aware is half the problem.
I would recommend an Anethesiologist (M.D.) (or having one nearby) rather than a nurse anaesthetist (just follows protocal).

I have a problem with the widespread use of Versed (Midazolam), a memory amnesiac, for consious sedation. See http://versedbusters.blogspot.com/ and http://www.medicalnewstoday.com/youropi ... onid=11517. If a traumatic event occurs, forgetting about it is too easy a solution, and may lead to a stress reaction. See my humble Letter to the Editor.

Let me repeat, I am not a Doctor, just a well informed patient, and Systems Engineer with good research skill.
Doctors hide their stethascopes and refer me to Helen Waite.

[fuzzy96]

it might be a good thing to get an oxygen adapter (if your mask does not have a port) to have on hand rather than having the staff scrambling to find one or just giving you o2 without cpap.

cpap.com has themhttps://www.cpap.com/productpage/O2-Enr ... apter.html
just some cheap insurance

good luck

[harry33]

its not unusual for people with undiagnosed apnea to stop breathing while under a general anasthetic and to have to be revived, sometimes the apnea is then diagnosed, sometimes not.

I had 2 genearl anasthetics with my apnea undiagnosed, sadly no one noticed my unusual snoring later

[nobody]

Is it general anesthesia? I have very severe apnea and I just had surgery a couple weeks ago with general anesthesia. I woke up fine and did not use my CPAP at all, although I did have it with me in the recovery area. This is the second surgery I've had and not used the CPAP during recovery. I think they use very fast acting drugs these days so it is not needed to put the machine on you unless you are having some problems waking up or keeping your oxygen up in recovery.

[nobody]

Oh yeah, thanks for mentioning that...both of my surgeries I have refused the Versed. It is only for anxiety and memory blocking, so IMO is not necessary (for me anyway). It's a benzodiazapine and maybe could make you groggy and have difficulty waking up...but I think they use only Versed during the so-called "twilight sleep" or "light anesthesia".

Good advice and also good that you are talking to your anesthesiologist before hand.

CNS depressants (anesthtics) reduce the threshold at which the neuoro system detects hypoxia.
So, (undiagnosed) Sleep Apnea patients are more likely to go into respiratory arrest, and may need mechanical ventilation. The fact that you and your Anesthesiologist are aware is half the problem.
I would recommend an Anethesiologist (M.D.) (or having one nearby) rather than a nurse anaesthetist (just follows protocal).

I have a problem with the widespread use of Versed (Midazolam), a memory amnesiac, for consious sedation. See http://versedbusters.blogspot.com/ and http://www.medicalnewstoday.com/youropi ... onid=11517. If a traumatic event occurs, forgetting about it is too easy a solution, and may lead to a stress reaction. See my humble Letter to the Editor.

Let me repeat, I am not a Doctor, just a well informed patient, and Systems Engineer with good research skill.
Doctors hide their stethascopes and refer me to Helen Waite.

[SleepyHead09]

i had to have both a colonoscopy and egd, the same day. i was very worried i would feel it or gag, but not a thing don't remember a bit about after they started the meds. they used a fast acting one called propavol(sp) looks like milk, only anastic(sp) that looks like milk. almost as soon as they stop the drip you start to wake up. i have a problem coming out of general, i had no problem with they propavol.

[howkim]

Propofol is a wonderful drug. They start it in the IV and you're OUT. They stop it, and you're waking. Almost instantly. And there's very little time to wait before it's OUT of your system.

[NEEDSTOSLEEP]

Just had knee surgery. I was told to bring my cpap also but then they said unless I was staying over night they wouldn't use it. I did fine.

[mars]

Hi Everyone

And especially to all the wonderful posters who have now given me the tools I need before I see the anaesthetist. So thanks to Slinky, Jay_R_1945, fuzzy96, harry33, nobody (who is definitely a somebody), SleepyHead09, howkim and NEEDTOSLEEP, and all who may post in future.

This is my summary as I now see it -

1. Talk to Anaesthetist.
2. Take machine and sleep study along.
3. Ask for anaesthetic that works only during the procedure, if that is possible,
otherwise see 8 and 9 below in the next post.
4. Avoid anti-anxiety and memory affecting drugs prior.
5. Avoid Nurse Anesthetists (no offence intended).
6. Confirm close observation will be in place after the operation, and apply cpap machine if still unconscious.
7. Try not to drink too much before arriving at the hospital.

Any further thoughts or suggestions will be welcome.

And just to tie things up here is the 2005 thread I originally looked at.

viewtopic/t42484/viewtopic.php?f=1&t=51 ... tic#p45488

cheers

Mars

[Slinky]

8] Buy and have w/your CPAP an 02 adapter to bleed 02 into line between CPAP and mask
9] Pack your CPAP Users Manual w/your CPAP or at least the Quick SetUp Guide

[Kiralynx]

Sometime in July I will be having a Gastroscopy and biopsies to check out my Barretts Esophagus. It is inflamed, and the last biopsies were indeterminate. <snip> Any thoughts or suggestions?

This thread

viewtopic.php?f=1&t=36909&p=321062&hili ... ch#p321062

has some useful information about prodedures, including a really useful URL by Ozij for detailed information on endoscopic sedation.

I had a colonoscopy in January, and they changed the meds I was given when they learned I had sleep apnea.

[dllfo]

STRANGE, BUT TRUE DEPARTMENT:

Make sure the hospital approves of your machine. Don't laugh, but when my wife had her knee replaced, the nurse said she could not use the Respironics BiPAP Auto until an ENGINEER approved it.

I plugged it in and she was using it, the engineer never showed up.

[kebsa]

i have jsut had surgery and took my machine with me as requested- i would have anyway- they are not likely to use it in recovery as they have you on continuous monitoring including oximetry and one to one nursing until you are maintaining you airway- there may be a lack of detailed knowledge re sleep apnea amonst the average nurse or Medico but those who work in recovery are focused on airway management and making sure that the patient is breathing and maintaining their own airway- its once you get back to the ward that you need to make sure that the cpap machine is plugged in raring to go and that someone know how to connect you up

i was pleased to say that my procedure was uneventful, the anesthetist was very conservative based on my history of MS and sleep apnea, i was having a relatively minor procedure that they would often use midazalam with but he did not think the amenisiac effects of midaz was appropriatte for a person with complex sleep apnea- he was apologetic as he said i may be a bit more uncomfortable that first night but said that he rather that and know i was with it enough to be able to protect my airway, use my machine eetc and i agreed whole heartedly- as soon as i got back to my room they fitted my mask and had me up and running


i have to have 2 more procedures in the near future and if the care is a good as this occasions i have nothing to worry about!

ps as an RN i agree wholeheartedly that we are not the kind of patients that nurse anaesthetists should be dealing with but thats just my opinion- the anaesthetic is the riskier part of many procedures so anyone with issues that may affect the response to anesthetic should have an experienced anesthetist not just a nurse specialist- the training levels are vastly different