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High AHI after general anesthesia
#1
High AHI after general anesthesia
My father had a colon surgery last friday to remove a malignant tumor from his colon.
For now, it seems like everything went quite fine despite his medical condition. (high blood pressure, diabetes, extreme obesitas, stage 5. CKD, several strokes and a heart attack in the past)
He was in the ICU for 3 days where they didn't use the BiPaP machine, instead they gave him oxigen therapy.
Yesterday he went out of the ICU and he started using his BiPAP machine again.

I just checked the data with OSCAR and his sleep was really terrible yesterday.
I'm attaching the OSCAR screen from the night before surgery (which is similar to an average night's sleep), and yesterday's.
He is feeling fine, just very sleepy during the day.

I'm can assume it is related to the medications for his pain (Fentanyl in ICU and now Marcaine)
They stopped giving the Marcain today to see if he still needs it. I will check tonight's data tomorrow morning.

Do you think this much change is normal in this situation?
Is there anything we can do to make his sleep better? I'm thinking about adjusting his settings somehow, but I'm not sure it would help.

We are informed how risky is this operation, that's why we try to give attention to every detail in his recovery.


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#2
RE: High AHI after general anesthesia
Major surgery is very hard on a person, worse when they already have disorders and conditions that reduce their vigor.  They're in pain, and that affects how they sleep.  Medications, whether temporary for pain or inflammation, or new ones to treat what already exists, are going to cause disruptions and require both the mind and the body to adapt.  Stress, which this all is, affects quality of sleep all by itself.  There's more anxiety, maybe some raised cortisol due to worry and pain.

So, on balance, I would say that what you see in the reports is 'natural'.  At least, it's natural under the circumstances, and how you see him affected is natural for him and his physiology.  You'll need to monitor and try to get the AHI under control as soon as possible, but making him comfortable and reassured, some of which he must accomplish for himself, will go a long way.
Serial Tapist
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#3
RE: High AHI after general anesthesia
It is very normal. They are keeping an eye on his O2 levels, correct? If so, then they'll know if/when it drops too low.

The older the person, the "harder" anesthesia hits and the longer it stays in their system. My father-in-law took a year to get back to himself after simple heart surgery. He was a freakin' grump (the politest word I can use). They kept him in longer just to ensure he was fine to go home. They had to put a big male orderly in there with him 24/7 after he threatened one of his kids.

I experienced more central events after my surgery a few years ago.
PaulaO

Take a deep breath and count to zen.




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#4
RE: High AHI after general anesthesia
Both charts show signs of obstructive event clustering, in hospital is worse but see how close he is to his normal bed position, think pillows.

At home I would recommend a soft cervical collar, I'd recommend it in the hospital too but they wouldn't understand why. You can try.

Read the soft cervical collar link in my signature.

As stated above, surgery can have a negative effect on apnea.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#5
RE: High AHI after general anesthesia
(01-14-2020, 06:54 PM)PaulaO2 Wrote: It is very normal. They are keeping an eye on his O2 levels, correct? If so, then they'll know if/when it drops too low.

Not since he left ICU. Maybe we should buy a pulsoximeter with an alarm function.

He is off from painkillers now, but tonight he got some (probably light) medications for insomnia. I'm not very calm about this seeing his last night's result.
I will definetely mention the results in the hospital tomorrow. They seem to take apnea seriously.
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#6
RE: High AHI after general anesthesia
Opioids reduce respiratory drive. So it’s natural that it will show up in increased AHI numbers. Once he tapers off all opioids then the AHI numbers will trend down again.
PRS1 Auto & Dreamstation Auto w/ P10 and straight pressure of 7cm. 
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#7
RE: High AHI after general anesthesia
I disagree an AHI of 60 is a normal post operative result. Of particular concern is the large number of CA events. Please review his therapy history and let us know what a normal night on BiPAP has been for him. This kind of result would have me calling the hospital and requesting they monitor pulse-ox on BiPAP and provide O2 as needed. The high rate of CA events may require an adaptive servo ventilator rather than his old backup if it continues. If he is using additional pillows he does not normally use, take them away so his chin does not tuck and close his airway.

Your chart excludes many important details. Please minimize the monthly calendar by clicking the ^ on the date line. That will allow respiratory data to display.
Sleeprider
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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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#8
RE: High AHI after general anesthesia
(01-14-2020, 11:03 PM)Sleeprider Wrote: I disagree an AHI of 60 is a normal post operative result. Of particular concern is the large number of CA events.  Please review his therapy history and let us know what a normal night on BiPAP has been for him.  This kind of result would have me calling the hospital and requesting they monitor pulse-ox on BiPAP and provide O2 as needed.  The high rate of CA events may require an adaptive servo ventilator rather than his old backup if it continues.  If he is using additional pillows he does not normally use, take them away so his chin does not tuck and close his airway.

Your chart excludes many important details. Please minimize the monthly calendar by clicking the ^ on the date line. That will allow respiratory data to display.

Hello Sleeprider. His normal night is the same as the first picture. AHI ~10 in average.

They are monitoring his pulse ox and he is on oxygen therapy for the day because of low saturation.

We are now trying to figure out how to connect the O2 with his Joyceone nasal mask. The nurses apparently have no idea how to do that. Sad

I'm not sure they will have the device for continous pulse-ox measuring, but I will definetely tell them to measure it often during the night.

I attach yesterday result with the calendar closed. It is a little bit better now.

Pillow removed for tonight.


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#9
RE: High AHI after general anesthesia
Tolnaiz, it is very easy to supply oxygen with CPAP or BiPAP. I wrote this wiki on the subject that shows how it is done and even how to calculate dose with the CPAP pressure dilution http://www.apneaboard.com/wiki/index.php..._with_CPAP

The device used to add oxygen is an "Oxygen Bleed adapter", and adapters are available for standard or heated tubing. Please do a search for Philips Respironics Oxygen Bleed Adapter.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


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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#10
RE: High AHI after general anesthesia
(01-15-2020, 12:14 PM)Sleeprider Wrote: Tolnaiz, it is very easy to supply oxygen with CPAP or BiPAP. I wrote this wiki on the subject that shows how it is done and even how to calculate dose with the CPAP pressure dilution http://www.apneaboard.com/wiki/index.php..._with_CPAP

The device used to add oxygen is an "Oxygen Bleed adapter", and adapters are available for standard or heated tubing.  Please do a search for Philips Respironics Oxygen Bleed Adapter.

Thanks. We don't have Oxygen bleed adapter, but on the Joyceone nasal mask there is a connector where (assuming) the oxygen can be attached. Is this okay to attach the oxygen?
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