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Anesthesia Concerns...Should I use CPAP in Recovery?
#1
Question 
Hi all!
Facing a "minor surgery" within the next two weeks. Was told I couldn't meet with the anesthesiologist until right before surgery. Huh

My doctor told me they use LMAC for sedation, and not to worry. As much as I try to find out what they mean, I am unable to get a straight answer, which adds to my ANXIETY.

Background: About 3 years ago, I had gall bladder surgery. The surgery itself went well, but the recovery did not. They were unable to wake me up for several hours. Of course, I didn't know that I had sleep apnea at the time! Since that experience, I am scared to death of being put out, and not waking up.

I have tried to talk to the doctor to see if I should bring my CPAP to use during recovery, but no one seems overly concerned about this, except Me.

My questions to anyone out there and especially Doc Wills is this:
What is LMAC? Is this the same as twilight sleep? Is recovery time short? Should I bring my CPAP even though the doc and hospital don't seem concerned?

Don't want to be a big baby, but don't want unnecessary anxiety either!
Thanks,



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#2
I'm not an expert. I think the L stands for LOCAL. And MAC stands for Monitored Anesthesia Care.
It sounds like local anesthesia for pain control; with sedation and of course monitoring of vital functions and blood gasses.
I could be wrong.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
Local Monitored Anesthesia Care. Monitored Anesthesia with Local Anesthesia and usually IV Sedation.

I will be having some Thyroid Surgery in August. ENT doctor is doing it (He is also my Sleep Therapy Docotor). I will not need my CPAP during Pre-0p, Operative, or Post-op (recovery). I will be spending one night during which I will have my CPAP with me but not sure if I will need it with the O2 they pump into your nose.

I was actually a year or two ago that an Anesthetist asked me after a procedure if I had sleep apnea. That and snoring finally sent me to have a study...
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#4
OpalRose -

Do you suppose that this is what your doctor was referring to? I watched a youtube video on how this is used and it didn't seem so frightful after seeing it.

https://en.wikipedia.org/wiki/Laryngeal_mask_airway

If I were you I would make a list of your concerns now and maybe revise your list as your surgery date approaches. Take that list to the hospital with you and ask the anesthesiologist those questions. Does your hospital call you ahead of time to "register" you? If so, you might be able to ask that person about bringing your cpap machine. Does your hospital have a website where if you poke around you might be able to find pre-surgical instructions of a general nature. On my hospital's site, it says to bring your cpap machine - which is what I plan on doing. If they don't feel I need it - then I will at least have it at the ready.
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#5
It is not an abbreviation we use in German medicine, but it might be referring to minimum alveolar concentration, meaning they would be gassing you rather than putting you under via IV infusion. In which case you will be getting a mask that will keep your airway open while administering just the right amount of gas to keep you under and rigid, so there is no pain. CPAP and apnoea are not factors for that sort of method. Recovery is rapid - if the gas-passer is gifted he will know how to bring you up at exactly the same moment the last suture is closed. Alternately it could refer to Monitored Anaesthesia Care, which is a protocol wherein the gas-passer constantly monitors airway, organ perfusion, breathing and bp during whatever sedation method they use, although this is now pretty much standard for any time we knock someone out (I prefer just hitting them on the head with a rubber hammer). Either way, whichever method they use, so long as they are aware of your needs, there is nothing to worry about.

Apnoea is very much in the forefront now of most every surgeon and gas-passer's mind when considering methods of operation, unlike 20 years ago. We are very much aware of the problem now, so as long as they know you have need of a CPAP, it will be taken into account in terms of the entire process. Commonly, if you are intubated, they will let you go through the bulk of the recovery time intubated and remove it only when you have shaken off the bulk of the anaesthetic. This obviates the need for CPAP. If you are overnighting it, bring your CPAP, but I don't think you will need it for an ambulatory op where you are going home the same day. Under such ops, you will doze lightly post op for around 20 minutes, not more.
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#6
(07-23-2015, 11:05 AM)OpalRose Wrote: Hi all!
Facing a "minor surgery" within the next two weeks. Was told I couldn't meet with the anesthesiologist until right before surgery. Huh

My doctor told me they use LMAC for sedation, and not to worry. As much as I try to find out what they mean, I am unable to get a straight answer, which adds to my ANXIETY.

Background: About 3 years ago, I had gall bladder surgery. The surgery itself went well, but the recovery did not. They were unable to wake me up for several hours. Of course, I didn't know that I had sleep apnea at the time! Since that experience, I am scared to death of being put out, and not waking up.

I have tried to talk to the doctor to see if I should bring my CPAP to use during recovery, but no one seems overly concerned about this, except Me.

My questions to anyone out there and especially Doc Wills is this:
What is LMAC? Is this the same as twilight sleep? Is recovery time short? Should I bring my CPAP even though the doc and hospital don't seem concerned?

Don't want to be a big baby, but don't want unnecessary anxiety either!
Thanks,

Docwils is right about this being monitored anesthesia care. When I debated having a septoplasty in 2014, this was type of anesthesia was offered as alternative to general. Anyway, this site might be helpful.

http://www.berkshirehealthsystems.org/mo...siacaremac

Regarding meeting with the anesthesiologist before the surgery, someone should be willing to meet with you and address your concerns. I get the sense they don't like to do this but if you're persistent, someone will see you. I lucked out with a resident who was very understanding about my concerns and did a great job in communicating the issues to the anesthesiologist who handled my case. Obviously, not being in the best of shape right before surgery, I wanted to make sure all my concerns were noted in my record ahead of time.

You're definitely not being a big baby as you are asking very legitimate questions.

Best of luck with your surgery.

49er
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#7
JustMongo,
Thanks for your reply. Just found out that LMAC stands for Local Monitored Anesthesia Care.

ddefendi,
Thanks and good luck with your Thyroid Surgery!

GrammaBear, thanks for the Link. I was taking your advice and making a list of my concerns and was going to call the hospital when the phone rang and it was them. They must have read my mind.....crazy lady with high anxiety needs answers! Crazy

DocWils,
Just got off the phone with hospital. LMAC is Local Monitored Anesthesia Care. They did address my concerns and said I would not need CPAP in recovery, but I could bring it if it made me feel better. Unsure
If all goes well, going home same day. But I will be watching for that Doctor with a Hammer. Wink

Hi 49er,
Thanks for the link, very helpful. I guess I won't see the anesthesiologist until 1 hour before surgery. They told me that they are aware of my Sleep Apnea and a Nurse Anesthetist will be monitoring me before, during, and after surgery. That made me feel better.

I think if anyone is facing surgery, whether it is minor or major, you need to keep asking questions and making sure they know your history, especially if you have sleep apnea.
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#8
Push push push for your questions to be answered. Write your questions down ahead of time so you don't forget a single one of them. When you ask, be specific. Such as:

When I am in the recovery room/ward, how will my sleep apnea needs be addressed?

Don't let them say "You won't be asleep." That's not the point. Unless they can guarantee you will be wide awake after the surgery and ready to drive yourself home, your sleep apnea needs will need to be addressed. You WILL be nodding off. Nodding off means closing air way. Which means desat O2. Which means alarms going off, disturbing other patients. Been there, done that, got sent home early.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#9
PaulaO2,
You are so right. My surgery just got scheduled for end of next week, and they will probably be sick of me before its all over.
They told me I wouldn't need CPAP in recovery because I wouldn't be out that long, but I will have it with me anyway and a family member will handle that for me if it's a problem.

I also told them when I am taken to recovery I do not want to be laying flat on my back, and to elevate the bed. I know if I lay flat without CPAP, my airway will collapse.

I can just see them rolling their eyes as I speak.
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#10
Hi OpalRose,
I hope your surgery goes well.
I would put my little sleeper friend in it's bag and take it with me as a sort of a "security blanket."
Better to have it and not need it, than need it and not have it.
Good luck to you.
trish6hundred
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