Difficult Airway.

[chunkyfrog]

The bullfrog found this paper that had apparently fallen out of the hospital folder
somewhere in the car in August after my surgery.
I never saw this at the time--"DIFFICULT AIRWAY LETTER"
It stated that I needed to notify my primary provider;
and purchase a medic-alert bracelet--plus notify any future anesthesiologists.
A copy is now in my medical record--but now I need to be proactive about
getting the needed details to the appropriate personnel--especially in an emergency.
If anyone else has experience with this situation, please speak up.

[Miss Emerita]

I don’t have experience, but this is a valuable reminder. I always pipe up about apnea, but I have to be sure my husband would too if I weren’t able.

[lynninnj]

In september i went to a wedding and sat next to a nurse anesthesiologist. She basically does what an MD anesthesiologist does.

I asked her about the significance of OSA after some back and forth.

During a surgery you would typically be on your back, which as you know increases risk of apneas. So throat collapses, you aren’t breathing ir inhaling anesthesia and problems can arise.

The team should be made aware of OSA before a survey for that reason.

Does that answer your question?

[lynninnj]

In september i went to a wedding and sat next to a nurse anesthesiologist. She basically does what an MD anesthesiologist does.

I asked her about the significance of OSA after some back and forth.

During a surgery you would typically be on your back, which as you know increases risk of apneas. So throat collapses, you aren’t breathing and problems can arise.

The team should be made aware of OSA before a survey for that reason.

Does that answer your question?

[palerider]

If you're put under general anesthesia, they intubate you anyway, so apnea doesn't matter during the procedure, and during recovery, they can just put in a nasal trumpet.

[stevenal]

Based on the frog's post, I just added OSA to the medical ID on my iPhone's Health app. This info can be accessed without unlocking the phone, so it should be accessible to EMTs when they arrive. A lot more info can fit here than on a bracelet.

[chunkyfrog]

I was intubated, in spite of the fact I was prone during surgery.
The anesthesiologist had difficulty inserting the tube,
noting my airway is anterior and I have a small mouth.
Apparently, she had to finish with a different blade than the one she first tried.
This explains why my throat was so doggone sore the first few days.
All my prior surgeries were when I was lying face up or on my side.
Since phones and jewelry get stolen, I might ask about a tattoo.

[lynninnj]

Based on the frog's post, I just added OSA to the medical ID on my iPhone's Health app. This info can be accessed without unlocking the phone, so it should be accessible to EMTs when they arrive. A lot more info can fit here than on a bracelet.

I did the same as well after returning from the wedding. I never would have even thought about it if it weren’t for the nurse.

[lynninnj]

For some reason, two of my posts were posted despite it being just one post but different points of editing.

There are several types of anesthesia that may be used for different procedures. IV, mask, local and regional. For the last two you will likely be conscious. (if you have ever been in the room for a lengthy childbirth where mom just tuckers and falls asleep despite the epidural then you know what I mean by *likely).

To be clear, despite statements to the contrary, not all anesthesia is given by mask. The OSA would be relevant info for the anesthesiologist to have because if IV is given and apnea occurs the anesthesiologist may then want to intubate. It’s not a given.

Intubation is a highly invasive procedure not given willy nilly for shits and giggles.

In response to chunkyfrog I don’t know the details of your surgery nor do I need to. You were probably intubated for whatever reason and that’s why the note.

Edit: For more info, here is just one of the many available tidbits of info. https://www.healthline.com/health/intubation

Whether using oral or nasal entry, if you have a lot of tissue at the back of your throat taking up space, which most of us do, the "difficult airway" label would obviously apply.

Here is more relevant info for those with obstructed sleep apnea. https://www.asahq.org/madeforthismoment ... eep-apnea/ The post-op treatment can be just as important as the OR table.

For more information: https://theanesthesiaconsultant.com/wil ... r-surgery/

HTH

[chunkyfrog]

IV is my preference; but you can't always get what you want . . .

[palerider]

stuff

From your own source:

General anesthesia can stop you from breathing naturally, so an anesthesiologist might intubate you to ensure that vital oxygen is delivered to your body while you’re unconscious.

For surgery, the intubation will be done once anesthesia has been delivered and you’re asleep.

For more clear understanding:

General anesthesia is a state of deep sleep or unconsciousness, during which the patient has no awareness or sensation. While it is possible for a person to maintain spontaneous respirations (breathe on their own) in this state, many cannot do so reliably and require support by their anesthesiologist. This support can sometimes be as little as a chin lift or jaw thrust to help open the airway, but typically involves placement of either an endotracheal tube (ET tube) or a supraglottic airway (SGA), a device that sits above the vocal cords. Both of these devices allow for adequate delivery of oxygen and anesthetic gases. Choice of device is determined by many surgical and patient factors. -- https://www.aegisanesthesiapartners.com ... nesthesia/

now, relating to 'difficult airway' (which is not 'I have OSA')

A 34-year-old morbidly obese man weighing 178 kg (392 pounds) was admitted for incision and drainage of a pilonidal abscess with fistulectomy under general anesthesia. He reported no major medical problems and no history of snoring. Upon initial evaluation by an anesthesiologist, he was found to have a short thick neck and a Mallampati score of 3, suggesting that endotracheal intubation might be difficult.

The patient was positioned supine with his head and neck in the ramped position plus sniffing position for endotracheal intubation. A high flow nasal cannula was used for preoxygenation and to help avoid precipitous desaturation in the event of difficulty intubating the trachea. A fellow anesthetist suggested that video-laryngoscopy equipment should be brought into the operating room, but the anesthesiologist assigned to the case rejected the suggestion. Anesthesia was induced with intravenous propofol and fentanyl, while neuromuscular block was obtained with intravenous suxamethonium. A first-year resident attempted to intubate the patient but failed. The attending anesthesiologist took over, but before intubation could be performed, the patient started to cough and desaturated to 40-50%. The anesthesiologist gave the patient rocuronium and sevoflurane, but he still could not intubate the patient and failed with a glide scope. He then gave 12 mg/kg of intravenous sugammadex to reverse the neuromuscular block. After about two minutes, the patient started to cough up bloody secretions and was administered 100% oxygen by mask. His arterial saturation increased rapidly to 100%. --https://psnet.ahrq.gov/web-mm/inadequat ... -hypoxemia

Should you make your anesthetist aware of OSA? sure, but that's not necessarily "difficult airway".

[lynninnj]

informative substantive info intentionally left out so maximum snark can be added when pr has only vacuous statements to add

From your own source:

General anesthesia can stop you from breathing naturally, so an anesthesiologist might intubate you to ensure that vital oxygen is delivered to your body while you’re unconscious.

For surgery, the intubation will be done once anesthesia has been delivered and you’re asleep.

For more clear understanding:

General anesthesia is a state of deep sleep or unconsciousness, during which the patient has no awareness or sensation. While it is possible for a person to maintain spontaneous respirations (breathe on their own) in this state, many cannot do so reliably and require support by their anesthesiologist. This support can sometimes be as little as a chin lift or jaw thrust to help open the airway, but typically involves placement of either an endotracheal tube (ET tube) or a supraglottic airway (SGA), a device that sits above the vocal cords. Both of these devices allow for adequate delivery of oxygen and anesthetic gases. Choice of device is determined by many surgical and patient factors. -- https://www.aegisanesthesiapartners.com ... nesthesia/

now, relating to 'difficult airway' (which is not 'I have OSA')

A 34-year-old blah blah

Should you make your anesthetist aware of OSA? sure, but that's not necessarily "difficult airway".

From above, the statement that directly contradicts your false statement that “everyone who gets general anesthesia gets intubated”: This support can sometimes be as little as a chin lift or jaw thrust to help open the airway…..

A careful and honest reader who isn’t falling over himself to insert snark would see that:

my sources are correct and there are no errors of fact or analysis;

I provided a possible explanation for the terminology.

That at that point in the conversation, I had no way of knowing what type of anesthesia she received.

I encourage you to step away from the computer when you feel you have to be dishonest about my posts.

[Janknitz]

They just have to take one look at me to know I'm going to have a "difficult airway" because of my genetic facial dysmorphisms. I have a significantly receded lower jaw, small mouth, and a very narrow and high arched palate (having teeth removed and retraction orthodontia only worsened this)-and a wide, short, "webbed" neck common with this genetic condition. I would expect anyone who is doing airway management in an emergency or in a hospital setting to be able to recognize and deal it, because challenging airways are not uncommon.

Fortunately, the once and only time I was ever intubated was 55 years ago when I had heart surgery (my most miserable memory of the whole thing was being awake in recovery while still intubated!). I've had some procedures in "twilight sleep", and I trust the anesthetist and recovery room nurses to be alert to airway issues. I've not needed hospitalization since my heart surgery (except for childbirth) but it's AFTER the recovery room that might be scary, when drugged up and alone in a hospital room with nobody paying attention. But my need for CPAP is clearly in my medical records and I would certainly make sure there were orders for CPAP if I have an elective procedure.

[palerider]

From above, the statement that directly contradicts your false statement that “everyone who gets general anesthesia gets intubated”:

In your zeal to vilify me, after I didn't even say *ANYTHING* about what you said, you misquoted me. Typical.

falling over himself

See above.

I was very careful to *NOT* do the things you allege, perhaps the snark is coming from the person you see in the mirror.

Give it a rest, please.

[chunkyfrog]

Please, the two of you--I love you both, so please agree to disagree.
Doctors do it all the time.