Reading time: 7 minutes
What’s inside?
- What are the risks when undergoing anaesthesia?
- What about the risks for my medical team?
- What should I be doing before the operation?
- Okay… I’ve been knocked out… what are they doing to me?
- Phew! I’ve woken up. Now what?
Many people will, at some point, need to undergo surgery involving a general anaesthetic, which means a fully trained professional pumping something into your body to temporarily knock you out.
If you have been in that position yourself, or even watched Grey’s Anatomy, you will know there’s a common phrase used by surgeons which goes something like this:
Every operation holds an element of risk.
Throw a patient with a collapsing airway into the mix and it gets a wee bit trickier still.
So… let’s have a look at what could be considered useful info when discussing sleep apnea with the medical team.
What are the risks when undergoing anaesthesia?
Breathing Complications
If I have sleep apnea, which I do … along with roughly 20% of the planet… I am at an increased risk of breathing complications during and after surgery.
Anaesthetic can depress the central nervous system, leading to reduced muscle tone in the upper airway, which can make my normal apnea events even more troublesome. This can result in low blood oxygen levels and higher blood carbon dioxide levels both of which can be life-threatening if not managed quickly.
Keeping My Pipes Open
One of the main concerns with sleep apnea patients undergoing anaesthesia is keeping the airway open. Patients sometimes have physical issues, such as a large tongue, enlarged tonsils, or a small jaw, which can make getting a breathing tube down the throat a bit more challenging. Difficulty in securing the airway can lead to problems where parts of the body don’t get enough oxygen, which can have a knock-on effect where serious things can go wrong such as inhaling stuff into my lungs that I shouldn’t (not a good idea), airway spasms and ultimately cardiac arrest.
Recovering after the op
Just when I thought it was safe to go back into the water, the risks don’t stop after the operation ends. When back in the recovery room some drugs, commonly used for pain management, can further depress the breathing function, making the effects of the anaesthetic worse. Continuous monitoring of oxygen and breathing rate is essential to detect and address any issues before they become a problem.
Other bits to consider
Before I leave the house to head for the hospital, sleep apnea has already flagged potential connections with other heart & blood flow conditions, including high blood pressure, dodgy heart rhythm, heart failure, and narrowing of all the tubes blood flows through. Stress of surgery (and reading this) can make these conditions worse, increasing the risk of something unconnected with my operation cropping up and giving my medical team more work to do on the day.
On the plus side, the odds are in my favour and medical teams are pretty switched-on when it comes to monitoring for this kind of thing.
What about the risks for my medical team
Keeping the Airway Open
Everyone in the operating room have an interest in keeping my airway open. After all it won’t look too good on the stats if the surgery is a complete success but I keel over through lack of oxygen.
Luckily, medical teams are again pretty switched on when it comes to both monitoring this kind of thing and acting quickly if the need arises.
Increased Workload and Vigilance
One thing we can’t get away from, in probably any country, is the high workloads medical teams have to manage.
Every Government and private company has targets… and most fail to meet those targets.
And who gets the blame?... Well, who do you think… the same people who are trying to concentrate on doing the best they can for the person on the table.
It is a high-pressure environment and this heightened level of care, such as monitoring everything needing monitored and reacting through making frequent adjustments, can take its toll by causing fatigue and stress across the medical teams.
What should I be doing before the operation?
Pre-op Checks
This is where the medical team get the first chance to assess how my own circumstances could impact their normal way of working. After all, most people they put on the table don’t have breathing issues.
What do I do?... I tell them everything and let them decide what to ignore.
They already have my medical notes, but what they don’t know is what I experience day to day.
- What therapy am I using?... as it can make a difference if I’m on BiPAP rather than CPAP.
- Do I use a full-face mask, nasal or just pillows?
- What pressure settings do I use?
- When do I normally use my machine?
- Are there any times where breathing is most difficult?
- How many apnea events am I currently experiencing during a normal night’s sleep?
- Have I experienced any heart or blood circulation issues lately?
- What medication am I currently using?
- Am I sensitive or allergic to any drugs?
All these, and any others I can think of, need to be handed over so the professionals can assess what bits are relevant and what are not. Sometimes, they may want to run further tests – such as blood pressure, or heart condition – before going ahead with the op.
If I’ve recently had a sleep study done, now would be a good time for the medical team to see the results of that too.
Okay… I’ve been knocked out… what are they doing to me?
It’s all about the airway
For a start, the medical team are going to pay more attention to my oxygen levels before knocking me out. This could include them giving me more oxygen, while prepping for the op, so my organs etc are topped up. This could make all the difference if there were to be a problem later and I my air intake was restricted for a short time.
They may also choose to stick a camera down my throat to get a better view of the airway itself. This could help should they need to insert a breathing tube.
These are the kind of things us patients don’t normally think about when going in for an op, so it’s handy we have professional people around to do the thinking for us.
Monitoring
As well as my heart rate the team will continue to monitor my oxygen, carbon dioxide and my breathing rate throughout the surgery. If I have significant heart or blood circulation issues then something more invasive may be required too.
Should any of these move either way outside the expected levels, the team will have all the information they need to correct it and keep me safe.
Phew! I’ve woken up. Now what?
Initial Recovery
Being a PAP machine user can make a difference to what happens next.
If a breathing tube was placed down my throat during the op, they’ll want to get this out safely. Unless there’s any risk of impacting the operation I’ve just had, it is likely I’ll get back onto my CPAP or BiPAP machine while resting in the recovery room. I’ll still be drowsy at this time and there’s a good chance I may fall asleep again, so introducing the PAP machine now can make all the difference to my comfort and recovery.
Monitoring and Discharge Planning
Many hospitals are now under so much pressure to keep the conveyor belt moving that I may be kept in for a day or 2 but could also find myself papped-out a few hours after the operation.
If I’m staying in, having sleep apnea will likely result in me being monitored a little closer than would otherwise happen. Things they are looking for may include lower than expected oxygen levels – as this could impact both recovery and general wellbeing – and keeping an eye on my apnea events to ensure the operation didn’t cause them to worsen.
On the day or later… at some point I’ll be discharged and this will likely be accompanied by clear instructions on the use of my PAP machine and what to do if anything unexpected crops-up that could impact me recovery.
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So, having sleep apnea can cause significant challenges for both us patients and the medical team when we need to get knocked-out for surgery.
This is mainly due to the increased risk of us having some kind of breathing or cardio complication but the fact we are able to get all our cards on the table ahead of the op means the team have all the information they need to make the right decisions, should they need to, during the op.
Communication between patients and medical staff is key here.
Us patients need to be open and honest by providing detailed information about our sleep apnea including how serious it is, what PAP devices we use and any previous problems we may have had when being knocked-out for an operation before.
Medical staff should be well-informed and prepared to manage the unique challenges presented by us sleep apnea patients.
By being open an honest we can help them help us. And that’s what everyone in the room is looking for.
Keep breathing!
Alan
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Absolutely No Wiggle-room Disclaimer:
Everything you read here is for informational purposes only.
No medical advice is given or intended… mainly due to the fact the writer is an interested sleep apnea patient with no medical qualifications whatsoever, is not a doctor, nurse, vet or even a pet shop owner.
He’s pretty good at researching a subject and pulling that research into something interesting though. Hopefully you agree.
Please consult a medical professional if you believe anything here could affect you or your treatment.