General anaesthetic & Apnea

Hi Everyone, I was in hospital on Monday, just 2 days ago for one of those manly operations ( a hydrocele - ouch ) and the anaesthetist insisted that because of my OSA I could not have general anaesthetic, I must have a spinal jab (epidural) and furthermore I could not have sedation either which makes you relaxed. I was not familiar with this and a little anxious but I actually preferred it and the banter with the surgeon and nurses until they put a screen up to stop me watching them. I am obviously in the UK and this was a private hospital and the anaesthetists rules are absolutely rigid with regard to Apnea patients, I even took my CPAP into the theatre but didn't use it, just had an oxygen mask and saline drip, however, the very same anaesthetists work also in the local NHS hospital and in that environment they are happy to supply general anaesthetic, I think they are frightened of being sued in the private arena. I would like to know what other countries guidelines are. English Eric

EnglishEric wrote:... and the anaesthetist insisted that because of my OSA I could not have general anaesthetic, I must have a spinal jab (epidural) and furthermore I could not have sedation either which makes you relaxed ... and the anaesthetists rules are absolutely rigid with regard to Apnea patients ... I would like to know what other countries guidelines are.

Here in the states it depends on the anaesthetist. Though general anaesthetic can be used, it is important to note that you use xPAP therapy. The anaesthetist can change their plan to administer anaesthetic and to keep the airway open. This is especially important for folks with central sleep apnea, since anaesthetic typically supresses the respiratory drive on normal individuals.

So, the key message is to be certain the anaesthetist knows about the sleep apnea.

general anasthetic is always risky especially if the apnea hasnt been diagnosed
a spinal anasthetic is often used if it can be, Ive had 2 operations with spinal block because of my apnea

apnea can cause problems when sleeping it off afterwards

I had arthroscopic shoulder surgery a week ago, under general anesthesia. I brought my machine and told everyone involved that I expected to be hooked up to it when I got to recovery, as I was intubated during the surgery, itself. I was assured that they would be keeping a close eye on me the entire time because of my apnea. Big surprise, I came out of anesthesia with no mask on my face and feeling awful...

I've never been fond of the aftermath of general anesthesia, but I think coming out of it was harder this time because of my OSA going untreated for however long I was unconscious in recovery (which felt like several hours but was likely just one or two). An extra-sucky experience.

FYI...The screen they put up is to keep the surgical field sterile, not to prevent you from seeing them or the surgery. They do it for those who are put under general anaesthesia as well.

I had a similar experience as BB, although mine was pre-apnea diagnosis! When I came to from the anesthetic, I felt like a lead weight was on my chest, because I couldn't breathe (airway wasn't opening fully) and panicked! Once I got the oxygen mask on, I was able to calm down, but all that day I had tachycardia. NOT FUN!

If I ever need surgery in the future, I might request a spinal block if possible, but I'd have to research the cons of that as compared to general anesthesia. I assume it would be better for an apneic. A conversation with the anesthesiologist would definitely be in order before-hand.

I had surgery in August with General Anesthesia. The anesthesialogist required I take my APAP along for use in recovery. APAP was applied in recovery. I had complication of not waking up from anesthesia and was nonresponsive to painful stimulu ending up with a neurology consult due to lack of responsiveness. Medical team does not know what the cause of nonresponsiveness was. While on XPAP, I had zero apnea or hypo's while in recovery. Then after I started waking up and afterwards had high AHI during hospitalization. I intially didn't want to take XPAP concerned for damage, loss of improper use (like not turning machine on after applying mask). Afterwards, was glad I did......softward data was very interesting!

Heal well from your surgery.

elg5cats

I'm reviving this thread because I am scared witless. I completely destroyed my knee (argh) and now require surgery. I understand that I may be able to request an epidural and not general anesthetic. I am scared of both outcomes -- I don't want to be awake for this operation, nor do I want to have general anesthetic.

Thoughts? Literature? What do I need to know? Would you always choose a spinal over general if you got to choose? My untreated apnea is 91 episodes per hour.

MoneyGal wrote:I'm reviving this thread because I am scared witless. I completely destroyed my knee (argh) and now require surgery. I understand that I may be able to request an epidural and not general anesthetic. I am scared of both outcomes -- I don't want to be awake for this operation, nor do I want to have general anesthetic.

Thoughts? Literature? What do I need to know? Would you always choose a spinal over general if you got to choose? My untreated apnea is 91 episodes per hour.

I worry a lot about this stuff myself, and I recently went though surgery under a general. Here's my advice:

1) Bring all your medications and a copy of your sleep study on the day of surgery. It may seem like overkill, but you'll fell better knowing that the doctors (especially the anesthesiologists) are fully informed of your situation and handling your treatment appropriately.

2) Bring your CPAP on the day of surgery. It won't hurt anything if you don't end up using it, but you'll probably need it during post-op recovery. It's harder to breathe when you're sedated, so they might put it on you before you're fully awake, especially if you have any breathing trouble. Besides, you might just want to sleep after surgery, and you definitely want your CPAP for that.

3) Ask a lot of questions. Write down a list of all your questions and concerns and talk to the doctor about all of them now, before the day of surgery. It helps me to write this stuff down because I tend to forget pieces when I'm in the doctor's office or hospital and all stressed out and scared. Make sure you mention your sleep apnea and CPAP if they don't ask about it.

4) Be an informed consumer. You're the customer, and you're in charge of your medical treatment. If you don't like what they're selling you, shop around!


Here's how my own procedure went down:

A few days before the surgery, the hospital called with a list of questions including CPAP usage. They asked me to bring my CPAP with me on the day of surgery in case I needed it during my recovery.

On the day of surgery, I talked to the anesthesiologist and mentioned my CPAP. He asked what my pressure setting was, but I was kind of frazzled and couldn't remember. Luckily he was able to find my sleep study in the computer (I had it at the same facility), and it seemed to be valuable information to him.

During actual the surgery, I was intubated with a breathing tube and monitored closely by the anesthesiologist, so I didn't need my CPAP. Afterward, I didn't end up needing it.


Best of luck with your surgery, and hope you have a speedy recovery!

I was supposed to have had sinus surgery today... general anaesthetic... when ever they removed the oxygen... I'd desat too much. They never even got me intubated.

So it didn't happen.

And yes I did tell them that I have sleep apnea... and TMJ and asthma.

But all I came out of it with was a really sore throat.

So now they're saying that if I want to try this again, it needs to be at the main hospital... more anesthesiologists that way.

I had surgery this past spring with a general and had no problem. The surgeon knew as did the anesthesiologist. I did have to take my cpap with for use in recovery and then in the hospital room once I was moved to one.

Gerry