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GrammaBear Offline

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Post: #1
somewhat disappointed
I recently had a surgical procedure in a hospital setting. Prior to the surgery date I had a phone interview with the surgery department and I indicated to them I have severe sleep apnea and use a cpap machine. I assumed that information was enough for them to be aware of any possible breathing problem. And yet when it came surgery time, there was no mention of any cpap machine or accomodation for the sleep apnea. Is it not the anesthesiologist job to monitor the breathing? I can't speak for anyone else, but when I lay flat on my back I do have trouble breathing. Obviously my procedure is done and over so nothing bad happened. I had a spinal anesthetic and I don't know if that affected how I was breathing. I was not completely unaware, but at that point I was too sleepy to say anything. Is there something I need to make my doctor aware of in this respect? Has anyone else experienced problems in this way?
08-23-2015 09:22 AM
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OpalRose Offline

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Post: #2
RE: somewhat disappointed
(08-23-2015 09:22 AM)GrammaBear Wrote:  I recently had a surgical procedure in a hospital setting. Prior to the surgery date I had a phone interview with the surgery department and I indicated to them I have severe sleep apnea and use a cpap machine. I assumed that information was enough for them to be aware of any possible breathing problem. And yet when it came surgery time, there was no mention of any cpap machine or accomodation for the sleep apnea. Is it not the anesthesiologist job to monitor the breathing? I can't speak for anyone else, but when I lay flat on my back I do have trouble breathing. Obviously my procedure is done and over so nothing bad happened. I had a spinal anesthetic and I don't know if that affected how I was breathing. I was not completely unaware, but at that point I was too sleepy to say anything. Is there something I need to make my doctor aware of in this respect? Has anyone else experienced problems in this way?


Hi GrammaBear,
Well, at least that's over with! I was wondering about you. This whole subject just angers me, because someone dropped the ball when listening to your concerns.
I am happy that all went well for you, but when the hospital or doctor asks you to fill out a survey (mine did), I would be sure to give them a piece of my mind!

I had same issues during my recent surgery, and even when I first got on to the operating table, they seemed to be unaware of my sleep apnea Huh, and that's after telling everyone I can in contact with. They did elevate the operating table, with the blessing of my surgeon, so that I wasn't laying flat.

OpalRose
08-23-2015 10:10 AM
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GrammaBear Offline

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Post: #3
RE: somewhat disappointed
(08-23-2015 10:10 AM)OpalRose Wrote:  
(08-23-2015 09:22 AM)GrammaBear Wrote:  I recently had a surgical procedure in a hospital setting. Prior to the surgery date I had a phone interview with the surgery department and I indicated to them I have severe sleep apnea and use a cpap machine. I assumed that information was enough for them to be aware of any possible breathing problem. And yet when it came surgery time, there was no mention of any cpap machine or accomodation for the sleep apnea. Is it not the anesthesiologist job to monitor the breathing? I can't speak for anyone else, but when I lay flat on my back I do have trouble breathing. Obviously my procedure is done and over so nothing bad happened. I had a spinal anesthetic and I don't know if that affected how I was breathing. I was not completely unaware, but at that point I was too sleepy to say anything. Is there something I need to make my doctor aware of in this respect? Has anyone else experienced problems in this way?


Hi GrammaBear,
Well, at least that's over with! I was wondering about you. This whole subject just angers me, because someone dropped the ball when listening to your concerns.
I am happy that all went well for you, but when the hospital or doctor asks you to fill out a survey (mine did), I would be sure to give them a piece of my mind!

I had same issues during my recent surgery, and even when I first got on to the operating table, they seemed to be unaware of my sleep apnea Huh, and that's after telling everyone I can in contact with. They did elevate the operating table, with the blessing of my surgeon, so that I wasn't laying flat.

My situation was similar OpalRose. I mentioned the sleep apnea to the surgeon when she came to see me just moments before they took me to the OR and she said "Well, you will be laying flat on your back" and that was it. Due to the nature of my surgery obviously my head probably could not be elevated since it was the opposite part of the body that was being operated on. For me, it is a little disappointing, it feels like sleep apnea is no big deal to them.........just like having high blood sugar (295) was alright with them. In regard to diabetes, what I wanted did not matter one iota.
08-23-2015 10:20 AM
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DocWils Offline

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Post: #4
RE: somewhat disappointed
No, it mattered, and there was someone there monitoring your s02sats the entire time, and keeping tabs on your breathing. The gas passer was in the room, and was on the ball - a cpap in the OR is neither necessary nor wanted (germs), if you had needed anything it would have been dealt with with the standby O2 that was just behind your head, even though you didn't see it. Weren't you masked the whole time with an O2 mask anyway? If not, there was one behind you.
08-23-2015 11:59 AM
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49er Online

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Post: #5
RE: somewhat disappointed
(08-23-2015 11:59 AM)DocWils Wrote:  No, it mattered, and there was someone there monitoring your s02sats the entire time, and keeping tabs on your breathing. The gas passer was in the room, and was on the ball - a cpap in the OR is neither necessary nor wanted (germs), if you had needed anything it would have been dealt with with the standby O2 that was just behind your head, even though you didn't see it. Weren't you masked the whole time with an O2 mask anyway? If not, there was one behind you.

DocWils,

It is my understanding that waking up in the recovery room is when the risk is greatest to the patient with sleep apnea as they are breathing off the anesthesia meds. That is why I must have mentioned a million times about my need for the VPAP after my septoplasty which I was allowed to have as long as I used the FitLife Mask.

Anyway, apparently, I woke up so quickly so it was never needed so the issue was moot. But I wanted it to be available in case it was needed and the anesthesiologist and surgeon agreed.

Not to speak for Opal Rose but I think when she said what she wanted didn't matter was referring to the feeling of doctors not listening. I definitely felt heard by all the doctors before my surgery but when I previously considered having the procedure, I can't say that was the case.

49er
08-23-2015 12:16 PM
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OpalRose Offline

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Post: #6
RE: somewhat disappointed
(08-23-2015 11:59 AM)DocWils Wrote:  No, it mattered, and there was someone there monitoring your s02sats the entire time, and keeping tabs on your breathing. The gas passer was in the room, and was on the ball - a cpap in the OR is neither necessary nor wanted (germs), if you had needed anything it would have been dealt with with the standby O2 that was just behind your head, even though you didn't see it. Weren't you masked the whole time with an O2 mask anyway? If not, there was one behind you.


Hi DocWils,
I hear what you are saying, and appreciate you taking time from your busy schedule to share your thoughts and wisdom, but I think the problem lies with not just Doctors, but anesthesiologist's too, is that they hear the same thing over and over and don't have the "time" to keep explaining to patients what the procedure is and the steps they would take should something go wrong.

Patients just want reassuring that they are being heard, and no one seems to have that kind of time, so in the end, the patient suffers needless anxiety.

I was more concerned that I would be able to use CPAP in recovery, not in the operating room. But it turned out that I woke up fast after surgery, as 49er did, and didn't need CPAP.

OpalRose
(This post was last modified: 08-23-2015 12:43 PM by OpalRose.)
08-23-2015 12:42 PM
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GrammaBear Offline

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Post: #7
RE: somewhat disappointed
I did not mean to imply that OR personnel were not doing their assigned duties. It wasn't decided until the last few minutes what kind of anesthesia I would be having, general or spinal. Spinal anesthetic I am not afraid of because I've had it before and it has worked well for me. However, general anesthetic has presented a number of problems, the least of which is waking up at mid point in the surgery and not being able to let someone know.

I am saying almost the same thing that OpralRose said, and that is I would have been most grateful if someone, even a nurse, had taken a moment and said, "We are aware of your issue with sleep apnea and anesthetic etc. and have taken steps to solve those problems should they arise."

My husband is a very laid back guy and when he had his appendix removed, he was completely unafraid of the whole process. I, however, with my procedure was in a state of panic for days ahead of time. I wish I was more like my husband and did not worry about so many things. I think worrying is not one of my better qualities.
08-23-2015 01:06 PM
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DocWils Offline

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Post: #8
RE: somewhat disappointed
Most people who get sleepy from a spinal in the recovery room actually drop off for a very short time, if at all, and usually because the adrenalin has worn off more than anything else, so they naturally drop off, but it is usually for so short a time that the need for a cpap is trivial, given the small chance that anything could actually occur that could damage you in that situation, and you are being constantly monitored as well, often with an O2 cannula still providing some supplemental oxygen, and if not, then your sO2sats are still monitored and a nurse is checking up on you every few minutes or less. We are talking a few minutes on the average, and the wake up is rapid. There is no strong opiod effect on the airway if you nod off post op from a spinal or local, so if there is a an apnoea event, you will wake up as you would normally, unlike if you are in recovery from general anaesthesia. Here the risk is higher, because the lingering effect of the anaesthesia may prevent waking upon apnoea events, and the recommended practice is either to retain intubation or provide some other form of support until the patient is fully awake and extend the monitoring time. For GM's case, monitoring is all that was needed, same for Rose. Notation would have been made in the chart for both of you, and in big letters at the top of recovery chart for the recovery nurse, or a flag or sticker. Before the op, in the op, after closing you up before transport and in the recovery room, there are checklists that the entire team has to go through verbally confirming everything. This is now SOP in both the US and in my country, and has been proven to cut down any complications or other problems, including mortalities, by a massive amount. So, if it was noted that you had apnoea and required a breathing device, then believe me people were aware of it every step of the way. The nature of the anaesthesia would have determined if you would need additional precautions beside extended monitoring and maybe supplemental O2 or not. Granted, smaller and older hospitals in the US may not be fully up to speed on the checklists yet, and HMO hospitals may be especially lax (I cannot tell you how much I loath the cost cutting bottom line methods of HMO systems in the US), but the checklist procedure is now fully establish in the US and will be found in most facilities these days. After all, if it spares problems, it spares insurance costs, even if it takes a few more minutes of the team's time.

I agree that a little reassurance goes a long way, and there, the bedside manner of your docs could do with an improvement. Maybe a lot - it costs only a titch of time, and saves a ton of anxiety.

As for the elevated blood sugar in GM, it was most certainly taken note of, monitored and a few extra precautions laid on that would not be seen by the patient, but honestly, would it have been even possible to wait for the sugar to normalise, given the current life situation and procedure needed by the patient? If the surgeon and the gas passer saw no greater danger in this, then there was no greater danger in it. The biggest problem in such cases is wound recovery, normally, not surgical complications, and a (very) minor risk of Ketosis. So wound maintenance is the real trick here - I usually suggest Keli-med crème in such situations. Vitamin-E crème or peanut oil also work a treat, but first the wound must close fully and be dry on the surface. So correct bandaging and infection protection is essential.
(This post was last modified: 08-23-2015 01:37 PM by DocWils.)
08-23-2015 01:25 PM
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me50 Offline

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Post: #9
RE: somewhat disappointed
when I had my colonoscopy and endoscopy. I spoke to the anesthesiologist prior to leaving the prep room. I realize they are busy but if you know that a patient has concerns, then taking a few minutes to listen to those so the patient knows the information was relayed to the "gas passer" then it should be done. I asked and I received.
08-23-2015 03:05 PM
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me50 Offline

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Post: #10
RE: somewhat disappointed
(08-23-2015 09:22 AM)GrammaBear Wrote:  I recently had a surgical procedure in a hospital setting. Prior to the surgery date I had a phone interview with the surgery department and I indicated to them I have severe sleep apnea and use a cpap machine. I assumed that information was enough for them to be aware of any possible breathing problem. And yet when it came surgery time, there was no mention of any cpap machine or accomodation for the sleep apnea. Is it not the anesthesiologist job to monitor the breathing? I can't speak for anyone else, but when I lay flat on my back I do have trouble breathing. Obviously my procedure is done and over so nothing bad happened. I had a spinal anesthetic and I don't know if that affected how I was breathing. I was not completely unaware, but at that point I was too sleepy to say anything. Is there something I need to make my doctor aware of in this respect? Has anyone else experienced problems in this way?

glad to know that you did okay through your surgery. you are braver than I am. I won't let them stick anything near my spine! welcome back
08-23-2015 03:06 PM
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