Repeated general anaesthesia

[Deleted]

DH is going back into hospital on Thurs for more surgery on his hand. His 6th GA in one year, with a 7th to follow three weeks later.

The docs all say, it's calibrated, it's no problem, it's an EXACT SCIENCE, there is ZERO risk.

Yet, we still have to sign the discharge papers.

My very close friends here both call BS too. One is a doc, the other is a nurse. Obviously, there IS risk involved. DH is fit (he was EXTREMELY fit before the accident one year ago). He's obviously less fit now, but he is still slim, so he is supposedly a great candidate.

I'm NOT suggesting that DH opt out of the surgery. His hand is still very lame, and he is fervently hoping for good results here. There is NO way he would opt out of this operation.

But, I'm still calling BS on the "no risk".

I guess I am absolutely terrified that DH's heart will conk out, after 6 or 7 or 8 general anaesthetics over the course of a year.

Gd forbid!

Am I wrong to fear this, or am I being realistic?

Sorry but I'm going to sleep now.

ETA: We TOTALLY trust the surgeon who is doing the surgery. My question is really about repeated general anaesthesia.

[Deleted]

I am hoping that Weltz and Shooby and other medical people weigh in on this.

[Tennesseer]

There is risk in just about everything. Signing the document is legal protection. Keep in mind many severely injured folks go through far more GA events within a year's time than your spouse. And yet most do come out fine.

[Deleted]

For any provider to tell you there is "no risk" involved is very suspect. There IS risk in ANY procedure, no matter what it is. There are all kinds of risks from infection, adverse or allergic reaction, human error, side effects such as nausea/vomiting, changes in hr, blood pressure and so forth. However, you have to look at the REAL risk. The real risks to having an adverse event in a young healthy person undergoing anesthesia is very small. Realize that you take "risks" everyday from crossing the street to driving your car to the grocery store. And, the fact that he has had successful anesthetics and operations in the past would seem that they are familiar with his case history and had no previous difficulties. There are also other ways to numb a hand besides general anesthesia depending on the location and extent of surgery and what needs done. Sometimes hand procedures can be done under local, IV Regional (Bier) block, or brachial plexus block and so forth. You would need to sit down and discuss ALL your options with your anesthesia provider. Some of these surgeries also involve placing a tourniquet on the limb which can be uncomfortable if the surgery is going to take hours so general anesthesia might be a better option. In addition, general anesthesia can be administered in a number of ways from endotracheal intubation, to mask, to use of a laryngeal mask airway. This should all be discussed and made clear to you before you proceed. But, anesthesia is indeed very, very safe.

[Abby Normal]

There is always risk. They'd be better off to say it's "routine" because that is what it is to them.

Be sure to ask the surgeon if there is any reason his/her ability to perform the surgury would be impaired. After all, surgeons are human and could have been out late the night before on a bender.

[Deleted]

Wow Tennesseer I have to admit it never occurred to me that people would go through more GA events but I am sure you are right.

Hopefully DH will come out fine too.

[Deleted]

Shooby I am also upset / worried because DH never discussed those options. I couldn't make it to that appt and he came home and (for a change) he was clueless.

This said, I'm guessing it is being done under GA, ie he'll be totally knocked out.

Thanks Shooby. As it gets closer I am getting increasingly anxious.

[Tennesseer]

Sept 25, 2012 20:19:31 GMT -5 @debthaven2 said:

Wow Tennesseer I have to admit it never occurred to me that people would go through more GA events but I am sure you are right.

Hopefully DH will come out fine too.

He'll be fine debthaven. If his health is otherwise good, you'll have him back to his normal self within 24 hours.

[Deleted]

All I know is that it is supposed to be day surgery. Both my friends said, no way, they will end up keeping him in overnight.

It is the law here that you have to have an appt with the anaesthesiologist within 30 days of a procedure. He told DH, you will need to be picked up, and watched over overnight. You need to sleep in the same room as somebody else. Do you have somebody close enough to do that for you?

DH answered, I think my wife will probably accept. LOL.

I guess it's just getting closer and I'm just getting nervous.

[Deleted]

BTW, newer anesthetic agents are quickly metabolized. The medications used most often would include propofol, fentanyl, and versed. If he is going to be intubated, then a dose of rocuronium or succinylcholine is then given which provides complete paralysis and facilitates intubation. The anesthetist then places the endo tube through the vocal cords and verifies positioning with End tidal CO2 and bilateral breath sounds, etc. The patient is then placed on a mechanical ventilator with settings based on the size and weight and other factors. Gas are then inspired usually a N20/02 oxygen mixture with at least 1 MAC (minimal alveolar concentration) of an inspired gas such as sevoflurane or desflurane. A BIS monitor is applied to which monitors EEG and the patients level of consciousness and anesthetic agents are titrated to maintain an BIS level consistent with unconsciousness. Additional narcotics are infused depending on the level of pain expected and surgeons may inject local anesthetics as well for good post op pain control. If paralysis is not needed, then instead of an endotube , an LMA may be inserted instead and the patient spontaneously breathes and inhales the inspired gases. Or, if a local with deep sedation, the patient may just be given propofol and other sedatives and placed on an on O2 mask if the surgeon is just doing a local. Pretty hard to say what the plan is since i don't know the type of procedure being planned.

[Deleted]

TY Agilemom.

I am definitely not worried about the surgeon, he has done 4 out of DH's 5 surgeries so far, he is a star. I totally trust him and so does my DH. When DH has an appt with him, they literally act like long lost brothers, they fall into each other's arms.

Thank you all SO MUCH for your support I need to go to bed now.

[Deleted]

Shooby thank you SO MUCH for the details! Frankly I don't know either but if you don't mind I will keep you informed!

[midjd]

Good luck, Debt! I know it's nerve-wracking, but everything will be fine. Just a typical day at the office for the surgeons/anesthetician.

[Abby Normal]

Good luck to your DH! He'll be just fine.

[saveinla]

debt,

I have had surgery where they put me under GA, but sent me home later in the day. So that is entirely possible. Good luck to your DH.

[Deleted]

I had surgery on my hand a few years ago. Outpatient surgery with nerve blocks and versed. I woke up in recovery with a big foam block with holes through it on my arm. It was yellow, so I called it my big block of cheese. The nurse attending me told me not to pick up my arm. Naturally, I did just that as I asked "why?". She lunged across the bed to grab my arm before I lifted it too high. Turns out, the nerve blocks take several hours to wear off so I had absolutely no control of my arm after lifting it. She had seen another patient smack himself in the face and cause a bloody nose.

[busymom]

I've gone home the same day after having GA too. Wishing him (and you) the best. Hope this'll be the last surgery!

[Deleted]

. Debt

[Deleted]

DH went under GA twice in one year a few years ago. Even though I knew the risks were low it was still stressful.

Best wishes for you and your DH - even though you know the odds are great it is still hard to watch.

[NastyWoman]

Sept 25, 2012 22:28:13 GMT -5 @bonnap said:

. Debt

[justme]

I've had 3 in the last year, possibly a 4th coming up. I had two within a week (unexpected bleed from the planned surgery) and no one said anything about an additional danger for going under again so soon. Also, I recently went under again, and they knew about the last two and didn't mention anything about more than normal risk. Obviously not up to the number your DH has had, but hopefully that will help to hear I haven't heard anything about 3 in a year. (And I probably would, even at 26 my mom asks a ton of questions of my doctors for things like going under!)

[The Walk of the Penguin Mich]

I'm getting ready to go under anesthesia for the 4th time next week for yet another surgery on my hip since December.

Yes, there is a risk when you go into surgery, but there is really no option. When I had my pre op appointment last week, I requested the same anesthesiologist, as the one I had in July did a superlative job. Apparently I cannot get her this time, so will request that the new anesthesiologist just do what she did a couple months ago.

I think your husband is probably safer than someone who has not had surgery. He's got a past record as to how he responds to drugs and the anesthesiologist is not going into it blind.

[mmhmm]

Oh, debt, of course you're anxious. Anyone would be! I'm just so glad Shoobs is here and could share her expertise with you. Hope everything goes wonderfully well for your DH and this will be his last surgery!

[Formerly SK]

I think your husband is probably safer than someone who has not had surgery. He's got a past record as to how he responds to drugs and the anesthesiologist is not going into it blind.

THIS. My 6yo DD has had GA 7 times in three years (one for spinal surgery, six for sedated MRIs). I feel safer after each incidence since they "know" DD's reactions to previous incidences. Of course you still worry, but that's the emotional side not the logical one.

[Deleted]

I guess I had no idea that so many people have multiple GAs!

Thank you all for your reassurance and good wishes.

We found out today that DH is scheduled very early (7:30 am), so it is indeed possible that he comes home the same day.

Mich, best of luck to you next week!

[Deleted]

From my experience (I have had several instances where I have had GA), they say the first time you go under GA is the most nerve wracking for the anesthetist. Some people do not do well with it - but if a person has been under once (or more) and has not had any complications while under or coming out of it, the odds of 'something bad' happening on subsequent GA instances shrinks...

[weltschmerz]

Debt, there's an inherent risk in everything. The fact that he handled the first GA works in his favour, plus the fact that he's generally healthy. A while back, I had 5 GAs in one year...I wasn't worried because I know I always bounce back quickly with no side-effects. Pisses the hospital staff off, but they like to err on the side of caution, and I'm ready to take off. That being said, the inherent risk I spoke of was something as simple as taking Motrin. It almost killed me and I was in Intensive Care for a really long time, with massive multiple GI bleeds and transfusions. There's always a chance of things going wrong, and that's why you have to sign the forms.
You're hubby handled the prior GA well, without complications. There's no reason to think this time will be any different. If you're still worried, is there any reason he couldn't do it under a local? Personally, I'd go for the GA myself. I want to sleep through stuff like that.

[Deleted]

My husband has had 5 "procedures" since February. They installed a stent, did something to his prostate, did open abdominal surgery on an abdominal aortic aneurysm, stuck something down his esophagus for a test and then "repaired" something causing internal bleeding, and then stuck the thing down again for more internal bleeding.

I am sure at least the first three of these were done with GA . . . maybe four. You just have to trust them.

That said, be sure whoever is in your PPO network. My appeal got denied. The patient must sit up in the operating room and ask everyone for their PPO credentials.

[weltschmerz]

PPO?

[wvugurl26]

Sept 26, 2012 22:08:33 GMT -5 weltschmerz said:

PPO?

Insurance network here. In her case not everyone providing care was a participant in the PPO, so she is stuck with a higher bill.