anestesia, surgery, OSA and central apnea?

I am looking at having surgery on my shoulder.

I just had a disturbing call from the anesthesiologist.
He read my sleep study report, and since I have severe OSA, as well as central apnea, he told me that I would have to have the surgery in a hospital and that I would have to spend the night...this is for a shoulder procedure that is usually done as an outpatient surgery.

I am quite upset to hear this. Not only does it scare me at the thought of the anesthesia, as well as the pain meds, perhaps causing me to be in danger of not breathing, but the cost of staying a night in a hospital is not what I had planned on. Also, the surgeon might opt out of the surgery all together, since he mostly works at his clinic's outpatient center...the SOAR clinic in palo alto, ca.

I understand that they just want to do the safest thing, but I'm just wondering about the reality of everything.

I'm actually contemplating canceling the surgery and trying to live with the pain. That doesn't thrill me either.

please share your thoughts

thanks

evan

nmevan wrote:The scheduler then said that I would probably have to have a new sleep study to give the anesthesiologist and the surgeon the new information.

This all seems excessive, expensive, unnecessary and time consuming.

The scheduler is wrong, imho (about probable necessity for another sleep study to get "new information.") And if the anesthesiologist or surgeon DOES want a new sleep study done, well.... I think that is totally unnecessary.

nmevan wrote:Has anyone had experience with any of this?

thank you

evan

I had surgery a year ago in an outpatient surgical clinic. The anesthesiologist came into the room as I was being prepped for the surgery, and expressed concern about "obstructive sleep apnea" being on my medical history. He said he would rather the surgery be performed in the hospital, not the outpatient clinic. I was getting dismayed, thinking, "uh oh... this is going to be cancelled and then rescheduled for in a hospital." I told him (truthfully) that mine was "mild" and that it happened almost entirely in REM.

Finally he asked me to open my mouth... "ahhhh." He was satisfied with the amount of openness he saw -- I guess he saw no reason he would not be able to get the breathing tube down my throat easily enough, because he let it proceed in the outpatient clinic setting.

Five and a half hour surgery... no problem. And no problem in recovery. My cpap was there beside the bed in recovery, but wasn't used. My throat was not the least bit sore aftewards, so the anesthesiologist apparently had no problem getting the breathing tube in for the surgery.

One would think that an anesthesiologist would be well versed and prepared for OSA in any surgical setting. I think it would be quite common.

I had wrist surgery this past summer. While it was done with a nerve block there was the possibility that general anesthesia would be needed. This was discussed with anesthesiologist at the pre surgery meeting. He looked in my mouth said no problem (assuming looking for adequate airway opening), advised me to bring cpap machine to have "just in case" and that was it. This surgery was done in an out patient surgical facility but they were prepared for general anesthesia. I had to sign the paper for it as part of surgery paperwork to give the okay for general should it be needed.
Cpap machine was never needed.

And I'm going to mention what happened to me... in a hospital.

I went in for sinus surgery... told the anesthesiologist that I had sleep apnea (and he looked at me blankly)... when they got me into the surgical suite and put me under, my airway collapsed and they could not get me intubated. The surgery ended up getting cancelled. I ended up spending hours in recovery without my machine (which was locked up and no one thought to bring me). O2 alarms going off and all that.

I have ultra severe OSA.... (had 178 AHI's in REM).... i just had surgery 3wks ago. It was made known that I had sleep apnea....

I brought my machine with me as instructed to, but when i was getting prepped, anesthesiologist looked down my throat in case they had to vent me.

I think them requesting all of that is unnecessary as well and I think anesthesiologists need to know and most know about apnea.... Didnt use my machine at all.

I have had 2 rotator cuff surgeries. The first was done at Stanford in Palo Alto CA. That is when I found out that I couldn't be intubated using normal intubation procedure. They had to use an LMA (Laryngeal Mask Airway). I had not been diagnosed with sleep apnea at that time. The second surgery was done locally in a surgery center. I told the doctor that I wanted an Anesthesiologist MD present and not a nurse anesthesiologist as I had sleep apnea and there was a problem in my previous surgery which I explained to him and gave him the report from Stanford. All that said I brought my cpap with me for the second surgery but it wasn't used. Every case is different so make sure you cover all bases with everyone involved in your surgery from the nurses to each MD involved. I would make sure you have a MD Anesthiologist during your surgery and if that has to be in a hospital so be it. Some doctors will tell you that there is less chance of getting an infection in a surgery center and that maybe true. However if it were me it would be more important to have the right person giving me anesthesia. Good luck with your surgery.

I changed the subject heading, hoping for more input.

I have had some fourteen surgeries in my life--ears, eyes, gallbladder, ears, ears, nose.
Seriously, I could practically do my own pre-op, if I knew how.
I just had my sleep study two nights ago, and got told I have severe sleep apnea that morning. I have never mentioned this to any doctors or surgeons before now because there was no diagnosis, no study, etc. They have never had a problem with me. The worst that happens is that I need a little extra oxygen when coming out of anesthesia in recovery room, and I hear even that isn't all that uncommon. I may take an hour or two to leave that room, and may have the oxygen and a sore place (flap in the back of the throat, can't think of the name), likely from the intubation, but I've never been told they couldn't intubate, or that I had really severe problems.

I think there's something to be said for being careful, and covering your bases, but what you've described, about them wanting you to re-test, and all the rest, seems really excessive to me. I think sometimes medical professionals get so scared of something going wrong that they make our lives more stressful by worrying about something that may or may not be an issue for you in and after surgery.

I hope you've managed to resolve the situation somewhat, or tha tyou soon can. I know how frustrating it is when doctors don't really listen to you.

Evan,
I understand your concerns. I would definitely have a conversation with the Anesthiologist. I Googled the subject and came up with a 3 page PDF that seems right on point.

http://www.anecare.com/Products/OSA-Protocol.pdf

Good luck and also remember that post op, you'll be using pain medication and probably sleeping in a different position then norm...so it'll be awhile for your numbers to get back to norm.
Jamis

I just had a kidney stone procedure where they used general anesthesia. It was done at an outpatient facility in Mountain View California.

I told the anesthesiologist about my sleep apnea and he really didn't seemed to be all that concerned. He was glad I told him of course so he could be prepared, but I think they are trained well enough to handle it on the fly. The reason I say this is because I had this procedure twice before in the same place a couple of years prior. At the time, I was not on CPAP and I never discussed OSA with me doctor, but I'd bet anything I did have OSA. I came through those surgeries without incident, so I'm betting they did what they had to do.

This time around I knew I had OSA and, like you, my AHI is > 50 without CPAP. The anesthesiologist used the laryngeal mask airway and said I'd be breathing on my own the whole time.

I don't really remember waking up. I didn't have my XPAP machine with me either. I figure if I had an apnea, my O2 would have gone down a bit and some alarms would have alerted them to my state.

Dave.

thanks for all your replies.

I just had a disturbing call from the anesthesiologist.
He read my sleep study report, and since I have severe OSA as well as central apnea, he told me that I would have to have the surgery in a hospital and that I would have to spend the night...this is for a shoulder procedure that is usually done as an outpatient surgery.

I am quite upset to hear this. Not only does it scare me at the thought of the anesthesia, as well as the pain meds, perhaps causing me to be in danger of not breathing, but the cost of staying a night in a hospital is not what I had planned on. Also, my doctor might opt out of the surgery all together, since he mostly works at his clinic's outpatient center...the SOAR clinic in palo alto, ca.

I understand that they just want to do the safest thing, but I'm just wondering about the reality of everything.

I'm actually contemplating canceling the surgery and trying to live with the pain. That doesn't thrill me either.

please share your thoughts

thanks

evan

Evan,
I'm a retired RN and have worked in ORs. It seems like a reasonable precaution to have the surgery in the hospital. They will monitor your O2 and you should have your machine there for the night. If the decision is cost vs safety...I choose safety any day.
Jamis

PS: Do you have a T port to plug O2 into your machine? Simple little device that might be handy to have in case they want to give you oxygen while using your cpap.

When I had my tonsillectomy & septoplasty & turbinate reduction, due to the OSA diagnosis, I was required to spend the night in the hospital.

Evan,

I noticed your post and when you said OSA and Central it caught my attention. I realize that there are a lot of issues with OSA but the CSA is also a cause for concern. When a person has Central only there is a lot of concern about anesthesia and most doctors will say that Central Apnea patients should avoid the use of any sedative medications due to their effect on the respiratory drive. My son, who is 100% Central Apnea, is not even allowed Versed (Midazolam - a very mild sedative commonly used on children for dental procedures) and his neurologist has him on automatic overnight stay with any medical procedures requiring anesthesia. If at all possible I would rather take the additional precautions suggested by the anesthesiologist, IMHO.

The following link has a lot of good info on apnea and sedation if you are interested.

http://www.sleepapnea.org/about-asaa/po ... rgery.html

I wish you well.