Risking surgery with General Anesthetic

[henryrootytoot]

Hi all. I'm posting this from the UK where medical practice might be different from the USA for example.
My question is directed to members with sleep apnoea who have had surgery or from doctors, not merely advice from anyone who has not.
So essentially the question is quite simple but the answer for the patient - me - could be critical in terms of successfully surviving the operation.
I am described as a "mild" sufferer of sleep apnoea but nevertheless have used a CPAP machine with varying success over the past few years. It has been modified to ASV output as my condition is changing to mixed apnoea, i.e. obstructive and central.

I am facing the prospect of having a repeat operation for an inguinal hernia as the first using open surgery and mesh failed. An aspect of the failure might have been that the NHS used local anesthetic, at my request, to remove any risk of using General Anesthetic. I'll not attempt to reiterate these risks here as they are well documented and anyone needing to have surgery should already have considered that risk.

Surgery for a recurrent inguinal hernia is very much more difficult than the first time around. Generally speaking the opposite method to the first time would be used which in my case would be keyhole (laparoscopy) surgery which by definition requires full general anesthetic. In my case spinal or block anesthesia has been offered but that too is difficult for me as I also suffer from peripheral neuropathy, nerve damage of unknown source to the legs.

So, if you have undergone surgery requiring anesthetic similar to what I am facing, or a doctor experienced in this I would very much appreciate your advice and comments. At present, the level of discomfort and the necessary avoidance of heavy tasks are bearable. That may not long remain the case. Dont-know

Thank you so much. Thanks

[Julie]

Hi, haven't had similar surgery, but have had others and the important thing is to emphasize to your doctor to tell the anesthetist (who may want to talk to you pre-surg, but not necess. so) that you have apnea - he/she (anes) will then know how to handle things and what to watch out for during the surgery. Plus it's important for the recovery room nurses to know what to look for and very possibly have you on Cpap til you're awake and on your way to your room. FWIW it's rare for there to be any related problems in general.

[Pugsy]

So in February of last year (2022) I had a back surgery under general anesthesia and I am still here. No problems at all.
They watch you like a hawk both during and after the surgery in the recovery room until you go home. Oxygen levels are monitored closely as well even after you leave the recovery area and are back in your own room.

Now I was told to bring my machine just in case something popped up but it was never needed.

[Conrad]

Hi all. I'm posting this from the UK where medical practice might be different from the USA for example.
My question is directed to members with sleep apnoea who have had surgery or from doctors, not merely advice from anyone who has not.
So essentially the question is quite simple but the answer for the patient - me - could be critical in terms of successfully surviving the operation.
I am described as a "mild" sufferer of sleep apnoea but nevertheless have used a CPAP machine with varying success over the past few years. It has been modified to ASV output as my condition is changing to mixed apnoea, i.e. obstructive and central.

I am facing the prospect of having a repeat operation for an inguinal hernia as the first using open surgery and mesh failed. An aspect of the failure might have been that the NHS used local anesthetic, at my request, to remove any risk of using General Anesthetic. I'll not attempt to reiterate these risks here as they are well documented and anyone needing to have surgery should already have considered that risk.

Surgery for a recurrent inguinal hernia is very much more difficult than the first time around. Generally speaking the opposite method to the first time would be used which in my case would be keyhole (laparoscopy) surgery which by definition requires full general anesthetic. In my case spinal or block anesthesia has been offered but that too is difficult for me as I also suffer from peripheral neuropathy, nerve damage of unknown source to the legs.

So, if you have undergone surgery requiring anesthetic similar to what I am facing, or a doctor experienced in this I would very much appreciate your advice and comments. At present, the level of discomfort and the necessary avoidance of heavy tasks are bearable. That may not long remain the case. Dont-know

Thank you so much. Thanks

I just went through something similar to this a couple of weeks ago. I had a colonoscopy and general anesthesia was required. I did not require any assists to my breathing however, but I was rendered unconscious. The doc and anesthesiologist were made aware of my apnea, and they took whatever precautions they take in such a case.

All was well, thank you.

[amenite]

Every opportunity you have when being questioned by staff or discussing the procedure, condition, treatment etc, mention your Apnea diagnosis and ongoing treatment to ensure it is in the record everywhere possible. Meet the anesthesiologist in person and tell them personally about it too. As long as everyone knows about it they will handle it. It's not a great mystery like it once was. I had a hernia surgery in 2019 and came through just fine. It started with me showing up day of surgery with my CPAP machine in hand, and mentioning it at every opportunity. They were playing Toto Africa on the surgical suite sound system as they put me under. I was happy to wake up because that would not have been my choice for a final song to listen to before I expired

[sauerkraut]

henryrootytoot;
Something You can talk to Your Doctors about for anesthesia might be a spinal block ..
I was given one for a inguinal hernia surgery years ago 1974 if I remember correctly ..
I was in the military so the reasons really were not given for using this instead of general ..
Good luck with the surgery !!
Steve

[CPAP-A-MUST]

In the US. I have mild OSA and had two knee replacements under general anesthesia 4.5 months apart and came through with flying colors. They monitored my SPO2 very closely.

[LSAT]

Over the past 5 years I have had 4 surgeries with general anesthetic...there is always an anesthesiologist there administering the anesthesia and possibly O2. He certainly would notice if you were in distress.

[loggerhead12]

I've been under maybe a dozen times for spinal injections, colonoscopies, and three surgeries. General isn't really anything to worry about. If there is any real risk caused by your condition they'll intubate anyway, which makes sleep apnea moot.

Anesthesiologists know how to deal with sleep apnea. Just make sure they know.

[chunkyfrog]

If your apnea is related to difficulty establishing an airway, it is best to be
discovered in a controlled setting, like a scheduled surgery, rather than an ER.
Now I not only have to inform any future anesthesiologists about my apnea,
I prefer to also give them a copy of my "difficult airway letter",
which details equipment used to achieve a good airway.
(Even though I probably don't "need" to.)
Kind of takes the fun out of surgery.

[palerider]

Hi all. I'm posting this from the UK where medical practice might be different from the USA for example.
My question is directed to members with sleep apnoea who have had surgery or from doctors, not merely advice from anyone who has not.
So essentially the question is quite simple but the answer for the patient - me - could be critical in terms of successfully surviving the operation.

You're making a mountain out of a molehill.

Your anesthetist has dealt with *plenty* of people that have OSA, just *tell them about it* they probably won't do *anything different* because they normally intubate the patient under general anesthetic, because the anesthetic will also paralyze your breathing muscles, so their machine has to breathe for you anyway.

The only time that the OSA may come into play is in recovery, and they may just stick a nasal trumpet up your nose for that.

Again, *just tell them*.

[henryrootytoot]

Wow many replies. I am honored and a little the wiser and more confident. Is there anyone out there in the UK please? Your comments would be particularly appreciated too. Thanks so much

[Julie]

Write to Rick Blaine - a UK member who knows all about apnea, Pap, the NHS, and anything else you might want to know re how things work there vs here. Just hit 'Private Message' (above right) and put his name in the search bar.

[PST]

I don't have UK experience, but I spent much of my life representing UK insurers who covered medical professional liability around the world, and I sincerely believe that USA and UK standards and practices are similar. Anesthesiologists have done a terrific job over the last 25 years of improving their patient safety record. Part of it is technology. Every variable like oxygen saturation and blood pressure is monitored electronically now. In addition, anesthesiologists were leaders in formulating standards that reduce surgical risk. A generation ago, when explaining the risk of surgery, surgeons would talk about "anesthesia risk" as if some irreducible small percentage of deaths could not be avoided. That attitude is long gone. One indication of the change is that medical malpractice premiums for anesthesiologists plummeted during the years I was in practice in comparison to those of other most specialists. In addition to the general factors reducing anesthesia risk, anesthesiologists have protocols for apnea patients that include longer monitoring of post-anesthesia care and postponing extubation in order to reduce the chance of having to re-intubate quickly. By the time I retired, the only cases I ever saw involving obstructive sleep apnea involved patients in which the condition had not been diagnosed but should have been suspected. I've had five surgeries under general anesthesia over the last 20 years (not counting things like scoping when the sedative sometimes puts me to sleep) and I feel 100 percent safe. These days, if they know you have apnea, they know how to take good care of you.

[chunkyfrog]

After receiving my letter, I went online to see what the various tools looked like.
I found many different shapes and sizes of "blades", to go with different devices,
(Some with with integrated cameras and video screens) allowing viewing and
access to the airway. Amazing tools!
Way beyond what is seen on TV!