This is Serious...

[muld00n]

In case there are still those that think Sleep Apnea is not a serious disorder:

http://www.knoxnews.com/kns/local_news/ ... 70,00.html

Steve

[rested gal]

Thanks for the link, Muld00n. Sad.

[tangents]

As a newbie, I'm confused by this article, relevant to the big picture. I gather we need to disclose the fact that we have OSA to the anesthesiologist before surgery, but is it the anesthesia during the surgery that presents the problem, or post-op pain management medications? Are we restricted in our pain meds because of OSA? Or is it only applicable after surgery?

[Guest]

No the meds won't be restricted, but the docs (& nurses) have to know about your apnea so they can deal with it, either by using different (though still effective) meds, or by using Cpap on you even if you're still out cold.

[Goofproof]

We should all have a Big "A", tatoo on our chest. No, Don't get it in RED! Jim

[bookwrm63]

For my scheduled surgery, I had to bring my cpap machine to the hospital and it was used while I was in recovery and of course throughout my hospital stay. This was for gastric bypass and I also had to be on cpap for at least two weeks prior to surgery or they would cancel surgery. All I know is that I woke up with my mask on!

[Goofproof]

I used mine in the OR, and hospital, for the barbarbic Defibulater Implant. Jim That was the only part that was done right.

[birdshell]

This is a very interesting article. Having had a number of surgeries, including a hysterectomy, I found the medical procedures described and the placement of legal responsibility to be somewhat of a puzzle. However, we cannot know everything as not everything will be disclosed in the newspaper.

I can only share what happened with the anesthetist and the anesthesiologist in my last procedure and surgery. I was told that the anesthesiologist always considers if one may have apnea; this seems a bit unusual to me, but I'm not a medical expert. I should think that the anesthesiologist (or anesthetist) would need to know as much as possible.

I would ALWAYS take a copy of my medications and allergies to a surgery or procedure, and (even if it has been submitted before) hand it to the person doing anesthesia when they come to the preparation area to consult with the patient (ME!!). I also tell every medical person that I seems to be caring for me about my apnea.

It would be a good thing for someone who may be able to give us a checklist, or a procedure, to follow in dealing with apnea and surgeries. I am basing this on my experience with bleeding disorders.

In the case of my bleeding disorders, I was required to have a bleeding time test and another blood test presurgically. NEITHER of these tell a THING about potential problems with bleeding during the surgery. So, I have to go in prepared to tell the medical people the definition of the most common bleeding disorder, the treatment for the most common bleeding disorder, and that I will NOT have an epidural. In case anyone might think that I am an isolated case, the same thing happens with many other bleeding disordered people. (One of these is my mother, and I have had to educate a number of her medical professional, too.)

[Bamalady]

yes, it is serious, and I am going to print the article to take to my Dr. He is a Professor at a teaching hospital. I had 2 similar procedures done there last year, about 6 weeks apart....and overnight for each. I was put to sleep for the first one. The anesthesiologist said he worked with many OSA patients and what he did was give them oxygen. I really had no time to object since I was going under. No extra effort was given to ensure I had my CPAP/Mask on afterward. My husband made sure I put it on after I came out of recovery.

I did have a conversation with my Dr. about the risks after the first procedure. When I went in the next time, I was not put to sleep, although I was given something. And the nurses made sure I had equipment later on.

I took my own machine both times, but they didn't check out my machine either time. Told my Dr. about this as well.

I'm supposed to have another procedure done, but am delaying it until they revise a few things.

I just saying don't assume that all will be well. Make sure you discuss everything beforehand if you need to be hospitalized.

[Sleepless_in_LM]

As a newbie, I'm confused by this article, relevant to the big picture. I gather we need to disclose the fact that we have OSA to the anesthesiologist before surgery, but is it the anesthesia during the surgery that presents the problem, or post-op pain management medications? Are we restricted in our pain meds because of OSA? Or is it only applicable after surgery?

During anesthesia, you will have a breathing tube in, so OSA is really not an issue. It becomes an issue when you are "awake" enough to breathe on your own and they remove the breathing tube, but you are still medicated to a point where your muscles are very relaxed and therefore are more open to OSA episodes. For my surrgeries, they provided O2 during recovery and I was strapped to an O2 monitor for my entire stay. I had my CPAP along, but they never put it on me, however I used it for sleeping at night.

[Sleepy Dog Lover]

Seems to me that the problem wasn't the narcotics, it sounds like she didn't have her cpap on. An interesting article that makes you think. Thanks for posting it.

[BrianRT]

Keep in mind that being intubated and extubated is traumatizing to the airway. This causes the throat tissue to develop some swelling, which can certainly exacerbate OSA.

[Bamalady]

During anesthesia, you will have a breathing tube in, so OSA is really not an issue.

I didn't have a tube. I think it depends on the kind of anesthesia used. I was, however, flat on my back, and out for awhile.

[flygal6]

Hi all.....very sad article indeed. Let me see if I can clear up a few things after reading many of your responses and concerns. I am a fellow CPAPer and also a recovery room nurse. I deal with OSA patients everyday. I'll and tell you how we deal with patients with a history of sleep apnea or have certain risk factors which make them more at risk after having anesthesia and then narcotics for pain relief. Our hospital has instituted a prescreening questionaire which all patients fill out so we can predetermine who already has a diagnosis of OSA and then which of the other patients may have certain conditions which put them at risk (ie:treated for high blood pressure, snoring, known apnic spells, or overweight) This way we have some advance notice about these patients. Anesthsiologists also somtimes pick up certain indicators by their interviews with patients preoperatively. First, yes its very important to make all your doctors aware of your OSA history, and esp. your anesthesiologist. We have you bring your mask with you to the hospital and then will treat you with CPAP, APAP, or BIPAP while in the hospital esp. at night while sleeping.
If you have a general anesthesia (put totally out with a breathing tube down your throat during surgery), you will actually be on a ventilator type of machine during the surgery (thats what the anesthesia machine does) It administers certain anesthetic gases, as well as gives you ventilatory support while you are anesthetized.
Now after the tube is out and you are in recovery waking up you will be on various monitors including B/P, oxygen saturation monitor and heart monitor. We unitlize all of these as well as close physical monitoring to assure you are breathing well while you wake up. But another critical part of my job is to also control your pain from the surgery....we do this by giving narcotics (like in the article) We closely monitor all patients, but use special caution in our OSA patients. We then assess how the patients have responded and collaborate with anesthesia and the surgeon on deciding if the patient need continued close monitoring in our intermediate care unit (like an ICU step down unit) or maybe they are doing well enough to go to a regular post-op unit, but we then send them with central telemetry monitoring with oxygen saturation monitoring as well. Had the patient in the article had this type of monitoring post op, the fatality possibly could have been avoided. Where I see the problem laid in the woman in the article, was not only a lack of communication between the surgeon and anesthesia, but also no special monitoring was done on the floor while the patient was in that first critical 24hr period when you are still blowing off anesthesia gases and then also on narcotics. Many of our OSApatients get pain pumps to use for pain control after surgery, but then we also use these additional monitors for their safety while on these pumps ..Our patients will use cpap regardless what unit they end up on....to continue to receive good oxygen and positive pressure we all need when we have this diagnosis of OSA.
I recommend to anyone going into the hospital to always take their CPAP gear with them and let everyone know what their history involves so the medical people taking care of us can better do this with all the facts.
Hope this explains a few things and answers some questions.
Carol

[Goofy-guest]

Wonderfully useful post, Flygal!!!

Thank you so much!!!!

Chuck