What happens to CSA people under general anesthesia ? Do we just stop breathing?

[S. Manz]

I am curious to find out what will happen to people who have Central Sleep Apnea on an operating theatre. Do they put him/her to sleep only to find that he/she stops breathing? How will they end up catching their breath, if they can't wake up under general anesthesia?
Just curious.

[speed3914]

Anytime I have had to have anesthesia I've been asked to bring my cpap

[car54]

Good question. 
I have been put under about 15 times. From what I understand I am intubated just like the covid patients. A ventilator breaths for me while the anesthesiologist monitors my vital signs. The tube goes past the larynx so you don't after worry about an apnea. Apneas may happen during recovery . That is why sometimes they tell you to bring your machine. It seems, at least for me ,they use propofol, the same drug Michael Jackson used. Recovery from it after a surgery is fast.
It's like you don't exist during that time. It's weird.

[DaveCar]

I had foot surgery, and mentioned that I have OSA and use a CPAP.
They did a spinal block on me, then kept me just on the edge of 'out' with gas.
BTW, spinal hurts .. but it sure works great.

[SarcasticDave94]

I make certain I mention Central Apnea during the preparation that goes on before surgery day, especially if talking with the anesthesiologist. I mention I had to be tubed during a surgery in 2016. Some tell me to bring the ASV, but it's only been used during one of my back surgeries in 2018.

Note that I've got a high Central count even without PAP, so I'm high risk yet there's been few issues or complications.

Since the initial Apnea diagnosis in 2015, I've had a shoulder scope, 2 colonoscopy, 3 EGD's, a bariatric sleeve, 3 different trials for spinal cord stimulator implant with the last being made permanent so 4 surgeries for this, a double kyphoplasty, and a lumbar nerve ablation.

[Sleeprider]

There are four different levels of anesthesia from minimal sedation, moderate analgesia or "twilight", deep sedation to full general anesthesia. The anesthesiologist is always prepared to take over vital functions like breathing at any time by intubation and full ventilation or pressurized non-invasive air. He has no need for your CPAP until you are in recovery, and it is in recovery, they may set you up with your CPAP or NIV PAP device. You are not leaving the operating theater until your vitals are stable enough to move to recovery. Like Dave, I have been intubated during deep sedation and full general anesthesia, but not during lower levels of sedation. The only way I knew of the invasive ventilation was by the level of sore throat after it was over. Ventilation is basic and routine.

[legrunt]

Once I was woken up, and as I was coming to, the doctor told me that there was a tube in me and they are going to take it out. Then they did and it made me feel like puking. Once the tube was out, I was left in a semi conscious state until I was awake well enough to be wheeled to my ward.

I tell you.... when I was waking up, I had absolutely no sensation of the tube down my throat. Felt absolutely nothing. Only when they pulled it out then I REALLY felt it coming out, like someone was yanking my throat out...

[cathyf]

A wrinkle that I only understood later and am wondering about...

I had a biopsy under general anesthesia a year ago. I was REALLY nervous as I've never had general. My mom is a nurse, and I was raised to fear it. (My mom always says that she has seen many medical mistakes in her long career -- people are human, humans make mistakes. But the only times she has ever seen mistakes kill patients are anesthesia mistakes. My mom never had novacaine for tooth fillings, and even talked her gynecologist into doing her hysterectomy under local!)

The anesthesiologists pretty well talked me off the ledge.   We talked about my apnea, and he suggested that he would intubate me further than they typically go -- there's a technique that makes sure that your airway doesn't collapse. So, yes, these guys deal with apnea every day. (My father-in-law was diagnosed with severe apnea during his septuple bypass surgery. Flatly refused CPAP.)

But what we did NOT talk about was the time between when they pulled the tube out and I woke up, and I really wonder what happened with positional apnea. I woke up on my back, kinda propped up on thick pillows -- the exact position that I would come to understand six months later will cause me astaonishing levels of obstructive apnea. But if that had happened then I would have desaturated pretty significantly, and that would have caused lots of excitement, right? What may have happened is that they were over-diligent about keeping my chin up. Because I have a pretty major "Goldilocks" problem, where I tuck my chin it cuts off my airway, but also if I tilt my head back too far, it triggers an attack of vertigo. (Think of how you hold your head at the dentist when they clean your teeth. Or for those of you who've ever had a thyroid ultrasound, that's the position.) I had a really hard time getting it together after I came out of the anesthesia -- I got dressed and was ready to get off the bed to go home, and I had to lie back down for another 15-20 minutes before I could manage that. I chalked it up to being a symptom of the anesthesia. Now I'm wondering if maybe I had a giant cluster of OAs or an attack of vertigo while I was out of it. In me, at least, I have similar reactions to vertigo & apnea -- I'm clearly fighting my body with a huge adrenaline surge.

If I'm ever going under general again, I'll bring it up. You've got to keep my neck just right or bad things happen to me! The talk is going to start with "at home I sleep in a cervical collar. A tall cervical collar, because the shorter ones don't cut it! So imagine the collar around my neck, and you need to keep my chin just exactly on the top of that imaginary collar."

[TonyVivaldi52]

I've had two general anaesthetics in the past month or so. Both times I mentioned apnea to the anaesthetist and both times they assumed it was OSA. If you have central apnea, you need to be specific about it. But as all the other people above have said, these people know their stuff and they are used to dealing with apneacs. The only problem you're likely to encounter is a sore throat from the airway tube.

[Ratchick]

I have CSA and I've had over a dozen surgeries under general anaesthetic. As far as I know, my surgeons didn't do anything special. If you're under anaesthetic, they are well prepared to manage any breathing issues to breathe for you if necessary. In every case I've been intubated (even before my CSA was diagnosed) and I've woken up just fine. A few times (around my diagnosis) I had a nurse periodically shaking me awake to take some deep breaths to resaturate myself once I was out of recovery and back on the ward, but they kept me on oxygen and a monitor until I'd had a few hours to sleep off the effects of the general and the IV pain medication. At the time, I wasn't being treated in any way, either. I know it sounds difficult, but try not to worry about it too much if you have to go in for surgery at any point. Make sure your anesthesiologist is aware of it, they will know how best to take care of you, and talk to the doctors/nurses at your premed before the surgery, they will probably tell you to bring your machine with you too. But during the surgery itself? It's pretty normal for people to have their breathing slow or stop while under anaesthetic and that's expected, so it's really not something you should worry about excessively.