"please keep me updated about oximeters "
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Post-Op Recovery Ordeal
from a Sleep Apnea patient who recently had nasal surgery -- the purpose of this report is to get us thinking about things that can go wrong, and what can be done to anticipate and correct them:
Report on Post-Operation Recovery for Nasal Surgery
• A Nurse told me there was no room on the High Observation Unit (which I didn't mind since my private room was nice). She pointed out it wasn't necessary. However, the anesthesiologist over-ruled her and said if they didn't make room there would be no operation. Turned out it was a good thing they made room.• The anesthesiologist came to see me and I asked (in a joking way) that she make sure she watched out for obstructions while I was under anesthesia. She told me that most apneas came from the brain. I pointed out that they don't with obstructive sleep apneas - only with central. She seemed a bit taken aback when I said that!• My CPAP went down to the operating room with me, ready to put on after I came round. I asked the recovery nurse if she wanted me to put it on, but she said there was no need as I was still attached to oxygen. I explained that oxygen wouldn't stop apneas happening, and some people with OSA have oxygen with their CPAP. She asked how they could administer oxygen as well. I showed her my mask, which had the plug over the oxygen inlet, and explained that's where the oxygen tube would go. She was amazed and said she'll tell the others!• When I was back on the High Observation Unit and very sleepy, I told the nurse that I would set up my CPAP machine. Again, I was told (by a different nurse this time) that there was no need as I was still hooked up to oxygen. I didn't want to make a fuss, so I just made sure I kept myself awake the rest of the day.• At sleep time I asked a nurse if I should remove the padding that was blocking my nasal passages. She told me to leave it on. I'm not sure if that was good advice, since things went horribly wrong when I had the high pressures blasting into my mouth only and straight to my lungs. I could not breathe at all and was kicked out of sleep 3 times - the 3rd time I had intense pressure in my head and my legs collapsed underneath me. I was in a state of panic by now! The staff did their best to understand what was going on, but it was a joint decision to remove the packing from my nose and try again. However, I pointed out that I wasn't sure what would happen with the CPAP blowing air up my nose, which was full of blood and gunk, so I wasn't confident about using it, as I didn't know where it would all end up. The staff didn't know what to suggest, so 'we' agreed (which did not give me confidence, as I was just the patient) that I would leave off the CPAP and would be put back on the monitor to keep an eye on my O2 destaturations. Problem is, everytime I went to sleep or even dozed, my O2 dropped and the machine set off the alarm. I realize this could be because I have an underlying problem, but it was still frightening to think I was in the hands of people who didn't seem to understand sleep apnea!The operation itself was 100% straightforward and I had full faith the surgeon. However, it seems the staff should be educated more in sleep apnea for the sake of future patients.
Views: 42
Replies to This Discussion
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Permalink Reply by Mary Z on
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How frightening! Out of curiosity di you have a fell face mask? I have heard of nasal sugery where they do not use the packing, though with the blood and crud in your nose thiss might not make a difference. Seems like a good heads up to have an in detail talk with your surgeon prior to the surgery. Thanks for the heads up.
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Permalink Reply by Mike on
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yes, i believe it was a Full Face Mask she was using at the time.
Mary Z said:How frightening! Out of curiosity di you have a fell face mask? I have heard of nasal sugery where they do not use the packing, though with the blood and crud in your nose thiss might not make a difference. Seems like a good heads up to have an in detail talk with your surgeon prior to the surgery. Thanks for the heads up.
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Permalink Reply by Steven Y. Park, MD on
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I''m a bit surprised by the anesthesiologist saying that all apneas during surgery are central. It's usually a combination of both. And believe me, I see obstructive events all the time.
I can't make comments on what other surgeons do since everyone does things differently, but in general I try to avoid using nasal packs in any kind of nasal surgery (septum, turbinates and even most sinus surgery). Patients are able to breathe well immediately afterwards and are able to go home after 2-3 hours. All the anesthesiologists know that every one of my surgical patients have obstructive sleep apnea and take every precaution possible.
The problem with O2 saturation monitors is that it'll go off all night long with most sleep apnea patients. In general, this gets the entire medical staff very nervous and they'll want to give oxygen or do something to increase the oxygen levels. What they don't realize is that this can be normal for most people. I've had a few patients bring their machines, but never had to use it. There are certain situations where you need to use CPAP while in the hospital, but in my particular situation with my particular hospital, there hasn't been a significant need.
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Permalink Reply by betty m on
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so very true!! the same thing happened to me in 2007! i could get absolutely no rest after surgery because my o2 kept dropping and setting the alarm off. they kept saying, breathe,breathe!
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Permalink Reply by Banyon on
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I don't want the impression to be left that you cannot use CPAP and breathe when your nose is blocked. I had nasal surgery and my nose was blocked for three straight nights. I used CPAP all night each of the three nights. I used a full face mask and breathed through my mouth.
It's not something I would want to do longterm, but for those three nights I had a reasonable amount of sleep and breathed all night. The data from my machine showed my AHI was well under 5 for each night.
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