General Anesthesia and OSA

[cflame1]

I knew that there'd be a problem... just wasn't sure what the problem was. So I'm going to write this out and maybe somebody else can learn from my problem.

I'd read on here and in other places that there could be a problem with general anesthesia and sleep apnea. It didn't really specify what the problem could be... just that it could be a problem.

12/17/09 I was to have had sinus surgery under general anesthesia. I talked to the nurse about the pre-op paperwork (we filled it out on the phone) on 12/15/09. I told them I had sleep apnea then.

On the morning of my surgery I checked myself in with my machine and they made sure that I'd brought it with me.

Did all of the paperwork.

Saw the anesthesiologist... he started asking me questions... I told him about the sleep apnea and the asthma... I had to repeat it... he still looked blank.

The nurses put my machine in a locker.

I was walked into the OR... they put on the gas. From what they tell me that when they removed the oxygen mask to try to intubate me, my airway collapsed in about a minute giving them no time to intubate me (and oxygen stats went bad). At this point I would guess that somewhere in there I bit my tongue and possibly the inside of my mouth.

They tried for an hour... then sent me to post op... no machine, no asking if I'd brought my machine.

Then it was to recovery (or somewhere anyways)... still no asking about the machine... I stayed there for a number of hours with a pulse ox on alarms going off left and right. As I was at the surgery center alone, the docs wouldn't release me (or call my friend) until they were done with their next patient... the ENT wanted to explain.

Wasn't until almost 5 hours later that one of the nurses got brave enough to have the conversation about my machine.

I checked in at 6AM... left there at 1PM.

Now they've told me that they could have done some intubation while I was still awake... why didn't they say that before???? And that if I should choose to do this again it has to be done at the big hospital... my ENT has to make special arrangements for it as he only works out of the hospital where it was tried on Thursday.

Screwed up medical system... they wouldn't listen and what do you bet I'll get billed for it?????? Plus probably have to do it again at the other hospital and what's to stop it from happening again???????

Lesson here: be very careful with surgeon's and general anesthesia... make it very VERY clear about your OSA. Get written post op instructions about your machine and bring it with you every single time.

What'll I do next time? Probably instruct the friend and have her stay... and lecture the ENT... and maybe get the sleep doc to lecture the ENT and the anesthesiologist.

[Gerryk]

My ENT is my sleep doc. I had no problems at all. Other than a little discomfort, I was so well taken care of I felt like I was at a resort.

Your idea of having someone stay is a good idea, it's not a good idea to have surgery with no one around that knows about you or your medical history.
If you feel they aren't listening to what you say, stop them and make them listen.

Best of luck next time.

Gerry

[cflame1]

I'm glad yours was easy Gerry... and I wish that everybody's was... but unfortunately mine wasn't. My ENT isn't my sleep doc... I have more respect for my sleep doc at the moment than I do for my ENT... but my ENT will probably do a lot of hard work to gain my respect back.

[TrueBlue]

I had the thing myself earlier this year. Even though I was told I would only have a very light anaesthetic and would be able to 'breath by myself' when I was under, I was terrified that they would leave me in the recovery room and no one would notice I had stopped breathing ! I made sure I told the nurse who booked me in and then the surgeon and the anaesthesist. They all seemed very familiar with sleep apnea and told me that someone would be with me all the time.

What did occur to me though was all those people walking around with sleep apnea who don't know they have it and therefore wouldn't know to mention it in such circumstances.

[elg5cats]

12/17/09 I was to have had sinus surgery under general anesthesiaI was walked into the OR... they put on the gas. From what they tell me that when they removed the oxygen mask to try to intubate me, my airway collapsed in about a minute giving them no time to intubate me (and oxygen stats went bad). They tried for an hour... then sent me to post op...
.

Was you surgery completed? cancelled?

elg5cats

[oneredtruck2]

I had sinus surgery On dec 3 my left sided was totally blocked. I had recently be disnosigned with
sleep apea. I found a ent. He didn't listen at first I told him no way I was going under general
So I went to surban hospital in louisville,ky. heagreed i even stayed over night. I talked to the dr that would put me asleep to him I have croncic asthma he didn't want to listen so I made him or surgery would not go through. I also have fear of pain. they put in totally out they had trouble with me stop breathing but was very well prepare . Don't go to same ent go to different one. Talked to them also I would fight them to pay bill. I don't pay for something that was there fault/ also do not fear them because they are Doc. your Health. I didn't take machine because I don't like mine. i am a new user/ Alice

[hobbs]

From the "other" place.

http://www.sleepapnea.org/resources/pub ... apuse.html

http://www.sleepapnea.org/resources/pubs/checklist.html

http://www.sleepapnea.org/resources/pubs/sameday.html

[ozij]

What'll I do next time? Probably instruct the friend and have her stay... and lecture the ENT... and maybe get the sleep doc to lecture the ENT and the anesthesiologist.

Next time you say to the surgeon, anesthesiologist and the nurses: "my airway collapses (I stop breathing) when I'm not fully conscious -- I even use machine to splint it when I sleep. How will you keep that from happening when I'm under a muscle relaxant or an anesthetic?"

Some people don't know what "sleep apnea" means. But they sure do know the difference between conscious and "not fully conscious" and they also know "stop breathing" and "airway collapses".

Your idea of having someone stay is a good idea, it's not a good idea to have surgery with no one around that knows about you or your medical history.
If you feel they aren't listening to what you say, stop them and make them listen

Two very good points.
O.

[Slinky]

Just make sure whoever you have come w/you is someone w/the moxie to stand up to the nurses and docors if necessary.

They are no help if they accept it when the doctors or nurses tell them they can't be present in recovery if you need them to be sure you are provided w/your mask and CPAP machine and turned on.

They are no help if they don't have the moxie to advocate for you when your instructions are at odds w/what the doctors, nurses, hospital staff say.

I love my husband, but he's still of an era where doctors walk on water. He wouldn't question them or advocate for me on my say-so before hand against what the doctor or nurse tells him at the time. I have one neighbor and my daughter I could trust to advocate for me if my instructions differed from the doctors or nurses. My son also would but he is too many states away. Everybody else I know would cave in to the doctors and nurses.

[newname]

When I had surgery they told me they hook me up to their big CPAP machine during surgery. Maybe that's how they knocked out my crown on my front tooth. they were putting in the tubes and the crown got knocked into my throat. they had to use the surgeon's (my obgyn) small forceps to grab it out of my throat!!
In recovery I was awake so they never did use my cpap which I brought with me.

[PaJoe]

About 5 years ago I needed surgery for colon cancer. The surgeon took the precautions of scheduling me to stay on the respiratory ward afterwards. I told everyone I had severe sleep apnea and my airway closes when I am sleeping. The anesthesiologist just nodded that she had everything under control. The next thing I knew I was awake on the operating table, choking, I looked and the room was full of doctors and nurses all staring at me as I flopped around the table grabbing at anyone to help, eventually I was out again, and when I woke in the recovery room they had some contraption holding my throat open - the surgery was aborted. I later learned they would pump me full of air and try to intubate me, but could not do it, apparently they go the idea that if they woke me I would be ok, but by this time my tongue had swollen from the hose being jammed against it. The following week the surgery was scheduled again and my surgeon found an anesthesiologist that had a reputation of being good with difficult airways and all went well. I learned that you have the legal right to request a particular anesthesiologist - which is what I did and will do if I ever need to go in again. The good anesthesiologist said he did not like getting into circumstances that require heroic action, he would abort if anything did not go well. I was told I would actually be awake until I was intubated, but would not remember any of it. Another thing they changed for me was the tube into my stomach, they normally have a tube release any stomach pressure after surgery, but because I needed cpap they did not use the tube on me. I also learned I need to wear a medical alert to inform first responders I have a difficult airway.



joe

[SuperGeeky]

Just an aside, I wear a Emergency 'Sleep Apnea' tag around my neck. I got it by donating to the American Sleep Apnea Association. I checked their website, doesn't look like they do it anymore.

None the less, even with ample time and preparation, the examples given are something to think about. Imagine 'emergency' surgery!!

Wearing a bracelet or metal around your neck notifying a Paramedic you have OSA is important.

I read recently, Paramedic Vans are increasingly being equipped with CPAP. Apparently, CPAP has other uses besides OSA and are quite useful.

SG

[TWW]

Huh. I am saddened to read this. There are good ones out there.

For me the experience was the reverse. The Anesthesiologist was the one who diagnosed me as having OSA. I'm told he predicted it just from looking at my chubby face, and that he intubated (is that the word?) me as soon as it manifested.

Were I you, I would tell subsequent surgeons "I have sleep apnea. I need an anesthesiologist who is prepared for it, and I also need my CPAP set up for post-op."

If they can't commit to that, I think I would try to find myself another surgeon.

[Trinity101]

I wonder if sometimes, the patient's machine is not used postop because they don't have a way to add the O2 tubing to the CPAP. Patients in recovery are pretty much always given O2, to help them wake up. I would check before I had surgery to make sure there is a way to easily add O2 to my mask, or get one that CAN be used this way, and then SHOW it to the nurse beforehand. That MAY alleviate some instances of patients not getting their macinnes used.
Also- an awake intubation is NOT fun, and most people would not really like the experience, so that may be why it isn't mentioned more, the doc thinking he can "Get it" once you are relaxed- bad thinking, but probably what most anesthesiologists think. I was a scrub nurse for 22 years, and I can almost remember every patient we had to do an awake intubation on- it was quite an event....remember , if you are sedated enough to not remember it, you are probably relaxed enough that your airway will collapse - the people we did awake procedures on, certainly knew it was happening.
A Medic Alert necklace is a good idea- unless they take it off before surgery...I agree that a good "partner" who can explain and then folow up if your CPAP is not used initially is a great idea. During surgery, they monitor your breathing and can ventilate you mechanically right from the anesthesia machine if needed. That is why they do not regularly need your machine DURING the surgery.
Hope this helps.
~joan

Throughout human history, we have been dependent on machines to survive. Fate, it seems, is not without a sense of irony. -Morpheus, The Matrix, 1999

[Muse-Inc]

Sheesh, I sure hope I don't need anesthesia anytime soon...y'all done scared me! I will insist that my sleep doc oversee-consult with whoever delivers anesthesia on me and I'm gonna train mom to the role she'll need to play for my survival in recovery. Never had a problem in the past...but then the last time was before the onset of apnea.