help: surgery and anesthesia

Subject: help: surgery and anesthesia
From: MAG
Date: 26 Jan 02 - 11:23 AM

I'm going in for minor knee surgery next Tuesday (double arthroscopy) and just found out that under a general anesthetic they stick a tube down your throat instead of just sticking something in your arm. Please tell me this is safe for the voice. The pre-op guys had to warn me about anything that might happen, and that "a few" people have sore throats for a couple of months.

PS: wish me luck. it will be nice to walk pain-free again.

Subject: RE: help: surgery and anesthesia
From: Jeri
Date: 26 Jan 02 - 11:34 AM

Personal opinion: this is over-doing it, possibly for the surgeon's convenience. I had arthroscopy (one knee) under a local and some general. The general anesthesia consisted of a couple of pills and an injection.

I had a ligament replaced which involved them laying the whole knee open. They gave me a para-spinal. No tubes down the throat.

Are you absolutely sure they said you were going to HAVE to be intubated? They may have just been talking about what they might need to do, not what they planned on doing. I'm obnoxious when it comes to my own medical care. I KNEW those guys didn't have to knock me out completely, and if they had wanted to, you can bet I would have made them explain why that amount of anesthesia was necessary.

Subject: RE: help: surgery and anesthesia
From: sledge
Date: 26 Jan 02 - 11:45 AM

The tube that that enters the throat is called an endo-tracheal, or e-t tube altough some tubes are put in place via the nose and are usually called naso-pharyngeal tubes, both tubes need to pass between the vocal cords to function effectively. This bit is done after they have stuck the needle in your arm. The jab or drip puts you out where as the gas administered via the e-t tube keeps you out until the op is over

The reasons such tubes are used are several:

First, they protect the airway for you when you are unconscious and unable to do it for yourself, protect it from what you may ask, saliva, blood or vomit. It is not too uncommon for people who are undergoing general anaesthetic to vomit as a kind of relex, and aspirating vomit leads to very serious problems for you lungs as you would be inhaling an acid solution.

Secondly it allows the ventilator (machine) to breath for you as being aneasthatised stops you from doing this yourself. To do this effectively there is a small balloon like cuff at the terminal end of the tube which is inflated giving a tight seal.

Having such a tube passed is usually very simple for the aneasthatist but you must remember that a large solid object is being placed where such things normally don't go and it often gives a little soreness afterwards though I have not heard of it lasting several months. I hold these instruments in very high regard as I work as a medic in remote areas and they really do prevent more problems than they are likely to cause.

All the best,

Stuart

Subject: RE: help: surgery and anesthesia
From: sledge
Date: 26 Jan 02 - 11:54 AM

Further to the above, Jeri may be correct in that the surgeon would like you out for the count, especialy as they may be considering further surgery there and then depending on what the arthroscopy reveals. It may be worth asking your surgeon this.

Regards

Stuart

Subject: RE: help: surgery and anesthesia
From: GUEST,MAG at work
Date: 26 Jan 02 - 12:40 PM

Yeah, there is some chance they'll take the rest of my knee out. I've been ignoring the pain until I could barely walk.

Due to a ruptured disc I'd rather avoid the spinal.

and yeah, they said the tube was a definite.

thanks for your patience, everyone. -- MA

Subject: RE: help: surgery and anesthesia
From: kendall
Date: 26 Jan 02 - 12:46 PM

I have to have the same thing when they remove my callous from my vocal cord. It is going to get crowded down there!

Subject: RE: help: surgery and anesthesia
From: winniemih
Date: 26 Jan 02 - 12:51 PM

I work as a nurse in a Day Surgery unit. You have the right as a patient to informed consent before any procedure,including the administration af anesthesia used during surgery. This is considered separate from the surgery itself. What this means is, you should have the opportunity to discuss your options with the anesthesiologist doing your case, and agree with his/her plan once you have heard all the options. If you do not get this information and give your verbal consent it is a violation of your rights. Usually (where I work, anyway) this happens just prior to surgery, as you wait in the holding area. Good luck with your surgery, and I hope you are up and walking without pain soon. Winnie

Subject: RE: help: surgery and anesthesia
From: kendall
Date: 26 Jan 02 - 12:53 PM

I have to have the same thing when they remove my callous from my vocal cord. It is going to get crowded down there!

Subject: RE: help: surgery and anesthesia
From: ermintrudeclaire
Date: 26 Jan 02 - 12:59 PM

spaeking from personal experience i would go for local anasthesia anythime, but not cos of the tube, that just makes your throat sore for a couple of days. generals just make me feel spaced out and puke for england. most ops are possible under local- so i was told- its just they prefer you out of it. if they give you general make sure its enough, they give you a paralysing agent so you cant move but its not fun to find you are consious and feeling them sewin up and you cant move a muscle to tell them!!

Subject: RE: help: surgery and anesthesia
From: ermintrudeclaire
Date: 26 Jan 02 - 01:01 PM

spaeking from personal experience i would go for local anasthesia anythime, but not cos of the tube, that just makes your throat sore for a couple of days. generals just make me feel spaced out and puke for england. most ops are possible under local- so i was told- its just they prefer you out of it. if they give you general make sure its enough, they give you a paralysing agent so you cant move but its not fun to find you are consious and feeling them sewin up and you cant move a muscle to tell them!!

Subject: RE: help: surgery and anesthesia
From: Jeri
Date: 26 Jan 02 - 03:27 PM

MAG, the ruptured disc may be another reason for the tube. Lying on the table for that length of time may prove too painful, even with other good drugs. Most people I've talked to have had a little bit of a sore throat and hoarseness after anesthsia because of irritation - nothing serious.

They have to inform you of every little thing that could possibly go wrong during surgery. I think the liklihood of serious damage to your vocal cords is low. I've heard of it happening, but I've never known anyone it had happened to, and I've known loads of people who've been intubated.

I will admit I'm scared of tubes, not because of anything reasonable. I absolutely HATE gagging. Most patients I've talked to don't remember gagging. Doesn't matter - I'm still scared. One day, I'll have to have major surgery, and I'll be whining at the doctor: "Why can't you just numb the skin and the whatsit you'll be working on? There's no reason I have to be unconcious if you're just gonna mess with my whatsit!"

I hope your knee surgery goes well. I had very little pain after mine, even with the ligament being transplanted from one place to another and the removal of a hunk of cartilage. If you're used to dealing with pain on a daily basis, you may feel a lot better VERY shortly after the surgery. I may just have been lucky. I also knew the pain I had was a healing pain that would eventually stop, and I'd have a functional knee.

Best of luck to you. I hope you have a friend who can smuggle in real food!

Subject: RE: help: surgery and anesthesia
From: catspaw49
Date: 26 Jan 02 - 05:18 PM

MAG, I hope it goes well and you're walkin' and rockin' in no time!

I've had a fair number of surgeries in the past 5 years and all have been tubed. I've also been on a vent for a 6 day stretch and even after that my voice was back to normal within a few days. Everyone, especially sledge has givenyou the basics and good advice...winnie's comment about rights should always be taken seriously. But the thing is, considering your back and the possiblity for more surgery then, it's as Jeri stated (I think)....it's no pain to you at the time and that table ain't no bed of roses! One additional thing the tubes do is give the docs another means of controlling things if something goes wrong. God forbid something should go wrong, but the more plumbing you have attached, the faster they can act on the emergency situation.

I've got a crummy voice anyhow, but I have never had a problem and I've never heard of anyone having a problem for "months." A day or three is about it.

Again, my best thoughts to you and you WILL keep us posted huh?

Spaw

Subject: RE: help: surgery and anesthesia
From: GUEST,jaze
Date: 26 Jan 02 - 08:56 PM

I've been a nurse for 20 years and currently work with anesthesiologists. I've never heard of anyone having a sore throat from intubation for more than a few days. By all means explore all options and choose what your most comfortable with. If doctors where I work told patients they'd have a sore throat for months, there wouldn't be much surgery being done. Best of luck with the surgery.

Subject: RE: help: surgery and anesthesia
From: GUEST
Date: 26 Jan 02 - 09:38 PM

Sore throat, dry, scratchy, things have an "off" taste - 2to 3 days , tops. They need the tube to keep your airway open, most importantly. Most surgeries of this kind don't require you to be out very long. The surgeon will make 2 short incisions, one for the scope and one for the repair tool. He or she goes in, looks, fixes what needs fixin'. The orthopedic Dr. concentrates on fixing your knee and the anesthesiologist concentrates on YOU and how you're doing, along with a few nurses. We've come a LONG way with anesthesia.

I had a general myself for outpatient surgery last week. I just have a thing about not being in control. Good luck with your procedure. Sharon

Subject: RE: help: surgery and anesthesia
From: GUEST,Where'd my cookie go? DancingMom
Date: 26 Jan 02 - 09:43 PM

previous post was mine. Sharon

Subject: RE: help: surgery and anesthesia
From: catspaw49
Date: 26 Jan 02 - 09:46 PM

Ya' know Sharon, I used to have a thing about that 'Control' idea myself. Then I ran into some non-optional situations and figured it was like riding an elephant downhill. There ain't no stopping it, so hang on and try to enjoy the ride!

Spaw

Subject: RE: help: surgery and anesthesia
From: GUEST,DancingMom
Date: 26 Jan 02 - 10:11 PM

Yeah, I know. In the LEAST it should be a learning and growing experience. It helped me to be on the OTHER end of the patient/nurse equation for once... S.

Subject: RE: help: surgery and anesthesia
From: Deckman
Date: 26 Jan 02 - 11:11 PM

I'm with catspaw! Both Bride Judy and I have had major ..."oh my gawd" ... surgery. At some point in time, you have to trust the experts. It always nice to be able to see and talk with your surgeon just before the operation (this is common procedure) if only to make sure he's not drunk and that he does remember your name. Best Wishes, Bob

Subject: RE: help: surgery and anesthesia
From: van lingle
Date: 26 Jan 02 - 11:46 PM

hi mag,had rotator cuff repair thursday morn so i'm a 1-hand typist for now. had a general and it was gas, a mask, no tube.operation lasted about 3& 1/2 hours. i awoke fuzzy from the gas, the narcotics or both and haven't had a sore throat but i am speaking and singing with a huskier tone. sang a little earlier this eve and like i say not sore but i don't i feel it would be if i pushed it.HTH. dave

Subject: RE: help: surgery and anesthesia
From: Mark Cohen
Date: 27 Jan 02 - 04:20 AM

Well, Mag, you're getting lots of advice here, most of it good, but I'm sure you're a bit overwhelmed. Here's one more idea to add to the mix: there's something called a laryngeal mask airway (LMA), which protects your airway about as well as an endotracheal tube, but leaves your vocal cords alone. Because you have two special considerations (your back and your concerns for your voice), I would suggest telling your surgeon that you would like a preoperative consultation with your anesthesiologist before the day of surgery. Then ask the anesthesiologist all your questions, and be sure to ask about the LMA. (My anesthesiologist used one for me, and my post-operative sore throat lasted about 4 seconds--literally!)

Remember, the anesthesiologist is a physician and you're his or her patient. It's important for you to communicate your needs and concerns, and to make sure all of your questions are answered, so that he or she can do the best job possible for you and your surgeon. Be polite, but firm, and don't take "Oh, that's just the way we always do it" for an answer. And do make sure you ask for a consultation, and not just a hurried checklist in the corridor outside the operating room.

Aloha,
Mark

Subject: RE: help: surgery and anesthesia
From: Dave Swan
Date: 27 Jan 02 - 11:30 AM

Let me add another vote for the LMA. If you're a candidate for it (not all patients are) it's a good airway which leaves your cords alone and leaves you feeling fine. I had one down my throat about a year and a half ago and was quite pleased. Mark is, of course, right as rain about a pre-op with the gas passer the day before, NOT on the way to the operating suite. Your life is in his/her hands in a most immediate way and you want to be comfortable with the physician, the tools and the procedure.

If, for some reason, you're not a candidate for the LMA, you don't need to fear the endo-tracheal route. Like some of the others here, I've passed more ET tunes than I can remember. Most of the intubations I've done have been so- called uncontrolled intubations. That's in the street, in cars, public restrooms, that sort of thing, without the aid of paralytic drugs or ventilators. What I'm getting at is that tubes done that way generally go just fine. When passed in a controlled environment by a physician with nothing but your airway and breathing to worry about, ET tubes are a safe and routine part of anaesthia.

Best,

Dave

Subject: RE: help: surgery and anesthesia
From: Stilly River Sage
Date: 27 Jan 02 - 01:04 PM

I agree with Mark (good thing he spoke up, because I couldn't remember the name of this system). I will have a bunion fixed one of these days, and my podiatrist says he doesn't do it with a local. I was scheduled for this surgery last spring, but got a bad cat bite on the same ankle two weeks before the surgery. We postponed everything until my plastic surgeon could get the wound to heal. And he suggested the LMA as a more comfortable way to receive annesthesia.

I had two surgeries in a row a couple of years ago, and in the first (outpatient) one the sedative was rather weak and I "awoke" upon arrival in the surgery and before the general anesthesia. I was out again quickly, and they proceeded with the surgery (I just had a chance to ask where was the classical music?)

I felt pretty bad for a couple of days, but slept it off at home. When the second surgery came around two weeks later, I commented to the anesthesiologist about rousing the first time under sedation, and he said they hadn't given enough. Trouble is, what he considered "enough" meant (I learned later) that the entire experience took a lot longer to get over, and required an extra night's stay in the hospital. While I was going into a day surgery to receive daily infusions for my cat bite I struck up a friendship with the surgery nurse, who said I need to tell the anesthesiologist about all of this, because it was the sedative that made the rest of it so much harder to get over. Sort of a one-two punch, where the first part impacts the second. I wouldn't have known anything about it if this nurse hadn't told me. In future I'll fine tune the process with the anesthesiologist, and as do as winniemih suggests above.

Subject: RE: help: surgery and anesthesia
From: MAG
Date: 02 Feb 02 - 04:41 PM

Thanks again, all: I asked for and got the LMA -- I know I'm just a worry wart about my voice, but the (bad) shape of my knees cost me my dancing days and the possibility of losing anything else I treasure is unthinkable.

Yeah my knees were a real mess -- "not a pretty sight" were the ortho's exact words -- but with lube injections he said they could keep me going until I am "old enough" for fake knees.

Yers, MA

Subject: RE: help: surgery and anesthesia
From: catspaw49
Date: 02 Feb 02 - 04:44 PM

**APPLAUSE** **BRAVO**

Good to hear from you and good for you!!!! I have friend doing the gel stuff and it's working well for her too. Best of luck!

Spaw

Subject: RE: help: surgery and anesthesia
From: Amos
Date: 02 Feb 02 - 05:23 PM

Best of all the bright lights on ya, MAG -- heal fast and get back into the stream.

A