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Re: Difficult Intubation ?
BigStu #246152 01/02/13 03:53 PM
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Hey, BigStu:

I had a very bad experience when I had Harrington rods placed in lower back: I thought it curious when the anesthesiologist came to ask if I were 'all right!" He complained that he intubates most people in 30 seconds but it took him over half an hour to set the tubes in me.

Having no memory of this (since I was already out), I just chalked the visit up to common politeness, but later that same day--when the pain killers wore off--I was miserable. And for three months solid had throat pain and soooo thankful for horehound candy! Oddly, I was saying similar things about the overall experience minus the candy part!

Next surgery was 20 hours (osteotomy) and felt fine in the throat department. This guy used childrens tubes or something less bulky; they can do it if planned for enough in advance.

And there was a subsequent issue when I broke my leg in Philippines--but things went Okay when they decided not to even try after I gagged so much upon first approach awake; every situation is different. Live and learn.

HEALTH,
John



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Re: Difficult Intubation ?
BigStu #246154 01/02/13 04:33 PM
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Thanks for the responses...I indeed spoke with the doctors prior to the procedure.I knew ahead of time that things were not going to be easy.He'll....we All know this...I guess I want the medical profession to take another look at the best way to intubate a curved neck.


Stuart Merenbloom-a 30 year sufferer of AS and still in pain most of the time:).
Re: Difficult Intubation ?
BigStu #246160 01/02/13 06:46 PM
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Just got off the phone with hospital p.r.department. They were very concerned about the situation. They will speak with medical staff. Also left message with SAA staff to call me. I am asking all of you with similar stories to do the same. If All of us tell our horror stories........


Stuart Merenbloom-a 30 year sufferer of AS and still in pain most of the time:).
Re: Difficult Intubation ?
BigStu #246161 01/02/13 08:07 PM
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I have always been "out" when intubated, but I always wake up with a sore throat that is between moderate and excruciating. I haven't noticed my neck hurting, maybe because other things hurt more.

My dentist says I have a small mouth, and I suspect I have a small throat either naturally or from scarring. I have trouble swallowing.

If I have surgery again I will definitely follow these suggestions, and I think getting the medic alert bracelet someone has mentioned is a great idea.

In the past I have had several health care persons not be understanding about not being able to lie flat, but lately most have been very considerate.

Re: Difficult Intubation ?
BigStu #246162 01/02/13 08:32 PM
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The record of the procedure should have which steps (if any) were taken to protect your neck. In addition the surgeons post procedure note should have the process written down on paper. Both are available to you with a request to medical records. The anesthesiologist report should also either on the pre procedure interview or the op report mention the fact that you have AS. That too is available to you.


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Re: Difficult Intubation ?
BigStu #246176 01/03/13 02:13 AM
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If you're going under general anesthesia, you're generally not awake during an intubation unless it's an emergency situation (just so no one about to have surgery gets scared by this thread) - you're awake while they pre-oxygenate you, and then they push a sedative/hypnotic and a paralytic right before the tube goes in. And if an awake intubation has to be done for a really difficult airway - usually when they're worried they won't be able to ventilate you or need you awake to evaluate - there's rarely any reason not to give a short-acting sedative so you don't remember the whole thing! Ugh. Stu, I'm sorry you went through all that, it sounds awful.

From my limited experience on anesthesia back in med school, I can tell you that AS is not on the list of pre-screening questions standardly run through by anesthesiologists. Everything that's been said above is good advice - be your own advocate, and don't sign consent until you're satisfied that they've got a good plan in place for you, including positioning. In addition to flexible tubes now, they may decide to intubate you guided by a video camera (glidescope!), or place a laryngeal mask airway instead for shorter surgeries.


@SeeSpondyRun
Re: Difficult Intubation ?
BigStu #246177 01/03/13 02:27 AM
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when i had my surgery for breast cancer in 2010, between my AS and the myasthenia gravis, they pulled the chief of anesthesia services out of the bag. we met once in the weeks before the surgery and between us, everything was discussed. i was not awake, but i know they used the flexible, and perhaps smaller tube, because my throat did not even hurt. with surgeries prior to that my throat felt like someone had scraped it with sandpaper. they were also accomplished before i had been dxd with AS.

that anesthesiologist also was with me for the last half hour before the surgery, discussing everything he planned to do to literally keep me alive for the long surgery (with the myasthenia, i cannot have any muscle relaxants, very prevalent in anesthesia). we discussed position, and possible emergency procedures, as i had to sign for them.

considering the great length of the surgery, that was the best surgery i had in my entire life. i cannot emphasize requesting another anesthesiologist to everyone here if the one you meet with doesn't want to see you until right before the surgery. we are special cases, and we need to be reassured that we will wake up ok.

i am so sorry stu, this was a really bad way to start the procedure.

medpgh has it right on, be your own advocate. at the last minute it is just you and the docs, your family can no longer express your wishes.

good luck, and stay away from all the surgeons you can, LOL. i know we can't.

s.

Re: Difficult Intubation ?
BigStu #246187 01/03/13 01:20 PM
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Just spoke with someone at the University of Maryland medical school. I hope SAA and the medical profession can join forces to start a coalition to develop a better way to motivate those of us with curved necks.

Again if you've been in this situation please tell SAA and me your story.


Stuart Merenbloom-a 30 year sufferer of AS and still in pain most of the time:).
Re: Difficult Intubation ?
medpgh #246188 01/03/13 02:40 PM
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Originally Posted By: medpgh
AS is not on the list of pre-screening questions standardly run through by anesthesiologists.


Would you be able to get ahold of a list that might be commonly used, medpgh? While AS may not be on it, I would imagine there is something on there about atypical anatomy, prior difficult intubations, etc. that ought to prompt spondies to tell the anesthesiologist if they have cervical spine involvement that could affect intubation.


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Re: Difficult Intubation ?
BigStu #246194 01/03/13 03:48 PM
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Yep - I'm no anesthesiologist, but I'm happy to share what experience I did have...I imagine there are slight variations from institution to institution, but they run through a checklist of at least the following:

History of cardiovascular disease, sleep apnea, GERD, snoring, respiratory disease, allergies, meds, respiratory disease, problems with your jaw, dentures, prior surgeries, anyone in your family ever have a reaction to anesthesia, any prior problems you've had with anesthesia (this should prompt discussion of prior difficult intubations, as you suggested)

Physical exam: examining mouth/airway visibility, ability to open jaw, touch your chin down to your neck and up to the sky

So, if you have fusion/limited range of motion, it will be caught in the above. The problem I'm guessing people run into is that this screening is done by anesthesia when you're already in pre-op. Ideally, your doctor should make them aware ahead of time, so that they have scans of your neck and whatever else they feel is needed for optimal preparation.

It would be a great idea for the SAA to include a heads up for patients re: advocating for yourself before surgery in their educational materials if they don't already!


@SeeSpondyRun
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