CPAP Machine into Surgery?

Hi all,

I have plantar fasciitis, and the podiatrist has suggested that I have a topaz procedure under Versed "twilight sleep" in the OR to help the foot. It would involve making me sleep, without intubation (tube down throat) for about 45 minutes, a nurse would "watch me", similar to what's done with a colonoscopy.

I have two questions:
1) Has anyone been able to bring their CPAP machine into the Operating Room (not the recovery room)?

2) I'm thinking I"ll insist on having an anesthesiologist rather than a nurse, (a nurse anesthesiologist would be OK), because if my oxygen saturation drops, it may take an expert to intubate me that point.

Any thoughts or experiences?

Happy Sleeper

My gut feeling is that they would say 'NO' to the cpap in the surgical suite. Sterile field and all that. It would be something that 1. was manifestly not sterile, and 2. not something they had directly under their control as to design and function. Be SURE you tell EVERYONE about your apnea diagnosis...at every stage. Don't be shy about it. It is not in their financial interests for you to die on the table, so they will do what is necessary (anesthesiologist, full anesthesia, whatever) to accommodate your apnea. But tell everyone! Good luck!

1. Discuss with your doctor, but also contact the surgery center you are having your surgery. Most will make the arrangements to allow your machine or provide one for you (bring your own mask). The hospital where I work in now evaluating people at risk for OSA and will be treating with apap post op but I'm sure they would also treat during "conscious sedation" like you are having. 2. As to needing an anesthesiologist, versed is easily reversed with romazicon though not often needed. Versed will make you very sleepy and relaxed but not unconscious. The nurse will be able to wake you up and you can answer questions but will not be likely to remember. It is even used safely for small children and even tiny babies in the NICU. Feel safe with your nurse.

Jason

Bring your own stuff for the hospital-stay. It's not that I don't trust the hospital, it's you'll feel more comfortable with your own equipment. Tell the doctors and nurses that you have sleep apnea.


Sheriff

happysleeper wrote:Hi all,

2) I'm thinking I"ll insist on having an anesthesiologist rather than a nurse, (a nurse anesthesiologist would be OK), because if my oxygen saturation drops, it may take an expert to intubate me that point.

Any thoughts or experiences?

Happy Sleeper

I have periodic injections into my back done under fentanyl. These take about five minutes and I stay in the recovery area about 15 minutes. I have a high tolerance to these types of drugs, but I find that in the recovery area the pulse oximeter frequently alarms. I don't know how low my sats go, probably not far. I find if I make an effort to breathe deeper the alarm stops. Since this is a 45 minute procedure I think a consult with your sleep doc, or a nurse anesthesiologist would be a smart idea.
Perhaps if they give you oxygen during the procedure this would be enough to keep your sats up. I don't know if a CPAP machine could cope with respiratory depression caused by the twilight sleep drugs.
Good luck, keep us posted.

I'm not familiar with the procedure that you state, but I do work for a well respected hospital (no, I am not a medical professional, so please take what I have to say accordingly) and I would just add that although it is not impossible to get the hospital to allow you to use your CPAP machine in the procedure room, the chances of it happening are slim. The hospital should have a CPAP device that you could use. The big issue is the liability of an unknown device in the procedure room is just too great. If something was to happen to you, regardless if it was because of your CPAP machine or not, there would be a whole world of questions and liability risk that the hospital would have to deal with.

On another note, a typical twilight procedure doesn't involve putting you to sleep. You are awake the entire time, but you will be relaxed and a bit sleepy. You will be able to follow simple directions and will be responsive. Chances are you will not remember the procedure at all after it is done.

Now granted, being relaxed may pose some risk with your apnea and the severity of it. I would talk to your doctor about your concerns and see what options are there for you. Also, talk with your ENT or whomever is working with you through your CPAP therapy. Remember that you have rights as a patient, and if you don't feel the guidance of the doctor or other medical staff is something you feel comfortable with, then you have the right to go look elsewhere and see if they can take care of you in a way that makes you feel comfortable. Make sure any medical care giver places the patient first.

- John

I have had both a colonoscopy (and its typical twilight sedation) and a recent surgery on my broken wrist.

I was advised by the anesthesiologist prior to the wrist surgery (nerve block with the twilight sedation) to bring my machine and have it handy in my room just as a precaution in case for some reason a general anesthesia was done and I ended up much more sleepy than I would normally be back in my own room where there is not so much close monitoring.

In the recovery room or the actual OR room I would be monitored closely with extra O2 line and probably would not go to sleep deep enough to warrant use of the cpap in those rooms. Someone would be right there should a problem come up. If a general anesthesia is needed for some reason...one gets intubated anyway.

He did advise having my own machine available in my own room "just in case" because it could quickly be set up to be used if needed. For the surgery center to have to go find a machine and get someone to set it up would take away from precious time I might need it if I was sleeping in my own room. Much quicker to have your own machine handy.

One of the worst times of my life was an aborted surgery for colon cancer. I warned everyone ahead of time about my sleep apnea and had my cpap machine along. However, the anesthesiologist they assigned to me did not take my condition seriously and after they were unable to intubate me they allowed me to waken on the surgery table but my throat was closed tight, a combination of the sleep apnea and swelling from the constant attempts to intubate me. I flopped around on the table choking, no air at all, while everyone stared at me wondering what to do, the last thing I did was grab a nurses arm and shake it trying to get them to do something. I woke up with some kind of contraption in my throat to keep my airway open and they had a respiratory specialist watching over me. I later learned from my insurance company I can request an anesthesiologist and they must use that anesthesiologist. I wrote to my surgeon and requested that he find an anesthesiologist that was experienced with sleep apnea patients, which he did. The respiratory specialists also decided not to use the tube into my stomach they usually do after colon surgery because it might interfere with my cpap.

I now request that same anesthesiologist every time, even if it is only a colonoscopy. However; for anything that does not require intubation, any anesthesiologist may be OK I was angry the last colonoscopy , as the surgery center told me I would have my requested anesthesiologist and he would be there but after all the prep and time off work I learned he was on vacation and I had to either accept another anesthesiologist or go back home and reschedule for another day- I will use a different outpatient surgery center next time.

Thanks all, those were very helpful answers. I think as I consider this "twilight sleep surgery" I'll ask my sleep doc if he knows of an anesthesiologist who is familiar with sleep apnea (last time I asked he did not , but that was a year ago).

Cheers,

Happy Sleeper

I had a plantar fasciotomy done with TOPAZ in June and was put under MAC anesthesia... but at that time I had not been diagnosed with sleep apnea....

Now, however, tomorrow I am having surgery and it was requested of me by the anesthesia nurse yesterday via phone to bring mine with me... I asked her why, and she stated that because they give surgical patients heavy doses of narcotics, when you have a sleep apnea sufferer, their breathing is already labored when relaxed... so this helps especially if someone has general anesthesia... she said it helps blow out the gasses faster.... it wouldn't be taken in the OR, but with you in recovery if your stats are too low. For tomorrow, I think I am getting a spinal and maybe MAC... I dunno yet.

(i even asked this question yesterday on the forum) LOL

I'll keep ya posted on what happens with me tomorrow...

Good luck w/the surgery and recovery tomorrow, Meowser!!! My understanding has always been that our CPAP would be wise and/or necessary in recovery, NOT during the surgery itself when you are constantly monitored by either anesthesiologist or CRNA (certified registered nurse anesthetist). We are not so closely monitored in Recovery - and - in some cases not so closely monitored as we should be.

The medical profession is catching up:

Upcoming Events
OSA, Sleep and Anesthesia, the Common Ground
Society of Anesthesia and Sleep Medicine
October 14 • Chicago Hilton Hotel
(773) 834-3407
Jtatum@bsd.uchicago.edu | http://www.anesthesiaandsleep.org

The objective of the meeting is to provide a forum for discussions pertaining to the common grounds between obstructive sleep apnea, sleep, and anesthesia. The goal is to promote excellence in medical care, research and education in anesthesia, sleep medicine, and perioperative medicine.

(The above from Sleep Review e-magazine).

Hi Slinky,

Good to see that seminar!

My understanding has always been that our CPAP would be wise and/or necessary in recovery, NOT during the surgery itself when you are constantly monitored by either anesthesiologist or CRNA (certified registered nurse anesthetist).

That's why I'm concerned, the podiatrist tells me that she's taking me in the OR because it's the only way she gets paid--and it's a sterile environment to do the procedure, but that I'll just be sedated lightly, so no need for close monitoring. That concerns me. I think I'll make sure that I do have an anesthesiologist or CRNA.

Meowser, please let me know how you do tomorrow, and also was your Topaz procedure successful for your plantar fasciitis?

Happy -

I didn't have to use my cpap machine at all yesterday. But I had it with me in the private recovery room while I was waiting for my spinal to wear off. but during surgery I was on my belly with a O2 mask on my face vice the nasal cannula. they asked me what my pressures were for my machine and all that while I was being prepped.

When I had my fasciotomy I had 2 nurses and CRNA and the anesthesiologist.... the TOPAZ worked for me. I also had the fascia partly cut to release the tightness. I love the fact that I'm not feeling like I'm walking on broken glass. I wore a surgical shoe for 3 weeks. You'll do great and get good results! I was put under MAC anesthesia... my Pod did an ankle block and a tourniquet was put around my calf to reduce blood flow. I couldn't feel my foot for close to 36 hours after the procedure... it was WEIRD! lol


Good luck!