Anesthesia advice?

[wubisnotanabbreviation]

My cardiologist prescribed my sleep study because she could not come up with an explanation for my atrial fibrillation that made sense to her. I was stunned to find I have CA. I never thought my poor quality of sleep was due to breathing problems. Also, when she tried electrocadioversion she said I was very difficult to sedate. It appears that when I am sedated, I also stop breathing, which tends to wake me up. I can certainly see this now in my sleep statistics. if I have a glass of wine too late in the evening - and I wake up during the night, I get stuck in a cycle where I almost fall asleep, stop breathing, startle and repeat, repeat, repeat, repeat... and my CAs go through the roof.

Now I'm in line for a hip replacement. My cardiologist told me it is very important to get my sleep doctor to talk to my anesthesiologist, and I can see why, but I'm having trouble convincing my surgeon and the hospital to show any interest in helping me get this conversation started. There is still some time before the surgery, and it may be they don't have a specific name yet.

Any suggestions for an approach that might help them see that helping me is a >good< idea? Do folks doing this sort of surgery ever use CPAP equipment? I want this operation to be just as boring as possible!

[justMongo]

Often the anesthesiologist isn't assigned until the morning of the surgery.
As Sleep Apnea has become more widely recognized, many surgeons are requiring patients to be screened before surgery.
They also seem to prefer that the patient bring their CPAP setup to the hospital.

During surgery the anesthesiologist is responsible for all life support functions -- including breathing and coagulation factors.
It's during recovery that the patient needs to be on their PAP setup.

In your situation, I think I would ask my cardio doc to write a letter stating all concerns. I'd hand out copies to everyone involved in the procedure.
Also, copies of your sleep study and PAP prescription.

[wubisnotanabbreviation]

Thanks! Not used to thinking of bringing my own tools to a hospital, so I'm mention that to my surgeon. And I will definitely ask for the letter from my cardiologist. Post-op, yeah that does sound a good time to be prepared!

[richb]

Your anesthesiologist should do just fine with your breathing. But as JM says the recovery room is the place for your xPAP machine. CA can also be associated with abnormalities in Blood Pressure. In my case my BP dropped very low during surgery. Make sure you discuss all of your conditions and medications with the anesthesiologist.

Rich

[justMongo]

Make sure you discuss all of your conditions and medications with the anesthesiologist.

Actually you need to get ahead of that. The surgeon should be well aware of your meds as there are some that must, and some that may, need to be discontinued by tapering before surgery.

The new blood thinners that are in pill form cannot be reversed by vitamin K1 during surgery; so clotting factor control is limited. Usually these are a must for d.c. (discontinue)

Sometimes beta blockers are preferred to be d.c. Ask the surgeon.

Certainly the the surgeon and anesthesiologist will have a conversation beforehand. Then you will meet the anesthesiologist outside the O.R. where he/she will speak with you. Let he/she know of your concerns.

[trish6hundred]

Hi wubisnotanabbreviation,
WELCOME! to the forum.!
Much success to you as you continue your CPAP therapy.
Good luck to you with your surgery.

[Kris the Crone]

Hi, wub! I had a total hip replacement last summer, and it was because of my difficulties sleeping post-op that I sought out an evaluation for sleep apnea and will be getting a CPAP/APAP soon. I was told before my surgery last year that if I used CPAP that I should bring the machine with me to the hospital. My obstructive apnea was undiagnosed at that time, but I told the surgeon and the anesthesiologist that I was sure I had it, and they listened. Had no trouble during surgery. Did have very low blood pressure for the first two days. During the 4 night hospital stay I only slept about 1 hour a day. Many people have a very difficult time sleeping post THR, sometimes for months. So your use of a machine should be very helpful to you, in the hospital and at home, so that your sleep will be as efficient as possible. Many surgeons require that you sleep on your back post-op for a number of weeks, in my case it was 6 weeks. I slept sitting up in bed, managed a total of 5 - 6 hours a day in short naps until I could get on my side again. Then I just went back to my normal bad sleep. I need another hip surgery and desperately want to avoid what happened before, so I am going the CPAP route.

All the best to you in your CPAP use and the upcoming surgery. There are a couple of really excellent hip replacement forums where you can get lots of info and support. I can guarantee you that it will be anything but boring!

[SideSleeper]

i just had knee replacement surgery and also had many questions about anesthesia. My knee surgeon's assistant did a thorough interview/review of my medical problems (apnea, tachycardia and some other items). An RN at the hospital then did another phone interview and asked many questions. I asked her about anesthesia since I had read an article on general vs spinal for this surgery, especially for those having SA. She assured me that the anesthesiologist would be aware of this interview when he talked to me in pre-op. I found out they use spinals for most of their ortho surgeries and I would be carefully monitored. I had a breathing tube and wore a pulse oximeter for the first 24 hours. I do have CA's but they are usually short and stay below 3 to 5/night--nothing like your problems. Some of my meds stopped nearly a month before surgery--especially vitamins and some supplements. I took my beta blocker right up until surgery. My hospital provided the CPAP machine--would not let you use your own--just your mask. With a spinal they didn't need to use it in recovery--just at night as usual. I was pleased they at least had a PR machine. I had to provide clearance from my cardiologist. They were very careful to do all they could to insure their patients have a successful surgery!

[49er]

Hi,

Before my septoplasty in 2015 which definitely wasn't as serious as your situation sounds to be, I insisted on meeting with someone in the anesthesiology department before the procedure. Sorry, this business of meeting with the person right before surgery in a compromised state just didn't do it for me and I had too many concerns I wanted to address.

They will initially provide resistance but if you are persistent, you can get a meeting. And yes, it mostly likely won't be with the person doing your surgery but after you discuss all your concerns, they can write notes in your chart so that the person who is doing your case can see what the concerns you have are before the surgery.

The person whom I spoke with was a resident because the hospital was connected with a medical school and did a great job in addressing all my concerns. When I walked away from the meeting, I had no doubt that things were doing to be fine and they were.

Anyway, I am just wondering if a meeting ahead of time might work better for you.

49er

[Sleeprider]

wubisnotanabbreviation, what is your treated AHI and CAI like? Are you continuing to have significant CA events with your Vauto machine? Generally patients with complex apnea require ASV treatment for full relief.