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About JM Starkman, MD
Expertise
I can answer questions related and specific to clinical anesthesia issues, problems, concerns and methods--both pediatric and adult. This includes matters that are strictly anesthesia in nature and also in other related medical specialties that impact various patient management decisions (e.g. asthmatic undergoing surgery) during or around the time of an anesthetic. I can answer questions about becoming a physician and specifically an anesthesiologist, and practicing anesthesiology. I am not a researcher or academic, so questions so-related are for someone else. I can tell you what a nightmare government involvement in medicine has been and will continue to be as it escalates.

Experience
Over twenty years of adult and pediatric, inpatient and outpatient clinical anesthesia practice--some private, some group.

Organizations
American Association of Physicians and Surgeons. My county medical society.

Publications
[not a researcher]

Education/Credentials
American medical school graduate. Board Certified. Fellowship trained Cardiovascular and Pediatric anesthesia subspecialist.

Past/Present Clients
Over 20,000 anesthetics, the majority of which have been personally managed, with less than 5% consisting of supervising nurse anesthetists or in-training resident physicians.

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Anesthesiology - anesthea & gallbladder surgery

Expert: JM Starkman, MD - 11/2/2009

Question
my wife needs to have her gallbladder taken out and she has copd uses oxygen at night only. how are the outcome's of people with copd and being put to sleep? she is so afraid of not being able to breath on her own after surgery. we know there are risk, but can you tell us more and what questions to ask the doctors? thank you.

Answer
The outcomes are variable and they are based on the skills of the anesthesiologist who is adept at anesthetizing COPD patients. Today's gallbladder operations are much easier on patients in that they are almost always done laparoscopically avoiding a painful incision impacting the ability to breath post operatively. To your wife's advantage, anesthesiologists and recovery room nurses deal with the relevant issues of awakening and recovering COPD patients quite often, so this should not be a major hurdle around the time of the surgery--i.e. her condition and planned surgery are routine/ many patients fit this description.

You should know that the politics of recovery rooms favor patients leaving the recovery room:
-----On time---in most hospitals a patient kept in recovery longer than a specified time period "falls out" for review, impacting the recovery room nurses and anesthesiologist who will be under the gun to explain what the delay was. This provides a strong incentive to have a protocol in place to assure a patient leaves on time, is stable, without pain or breathing or nausea, etc. complaints.

-----Without the need for unexpected hospitalization or ICU admission--incentives as noted in #1 above.

So, there is little need for serious concern. But to ask all the right questions:

     1. Arrange to meet with the anesthesiologist several days prior to planned surgery. This will allow him to evaluate your wife's medical history
          and make any plans he prefers to optimize her status preoperatively. Ask him how he makes specific treatment plans for his COPD
          patients----he should have some specific answers other than "I watch them closely", etc. If he has not won your wife's assurance after
          that meeting, ask your surgeon to schedule the operation elsewhere.

      2. Don't permit this to be scheduled in a surgery center-- get it done at a hospital. In the unlikely event there is a problem, you'll want a
           complete respiratory department and ICU available right away.

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