Expert: JM Starkman, MD - 2/3/2010

Question
I am due to have a short proceedure (D & C) for uterine lining build up (post menopausal) Next week feb12.in outpatient but in Hospital.
I had a nasty virus cold turning into bronchitis 2 months ago. I am better but still have bronchitis type dry coughing( live in desert too if any consequence so it is dry enviro) I cant seem to shake this cough. I postponed this proceedure once already from the cough, I cant wait any longer. Incidently im 55 yrs old and obese/298lb ( all my blood work ect looked fine everything normal)
and my bloodpressure is usually under control with lisinopril)
I want to know will they be able to deal with my situation and do the general anesth. or offer me epidural?
I have had a bad memory of waking up not breathing during or after surgery (when i had my child 28 yrs ago. I had general anesth. in 1990 3 times. no big problem other then that horrible i cant wake up feeling.
But with Bronchitis ( and i have been told i could have copd) but my chest xrays are clear i had 3 in last 2 months. My problem seems to be in the bronchial passages.
So with that said, I need this proceedure done desparately as i live with pain in uterus (scale to 3), almost every day.
Will i be able to get this done next week? Or will they want to postpone. I was told I will be only under for 15 to 20 min. Will that help in alleviating any choking problems attributing to my bronchitis ?  I do have anxiety disorder and take a half of an xanax once a day evenings to help me relax to sleep then take trazodone.  As since my bad experience with last sickness and hospital visits for it(in which they did nothing but test this and that) I fear sleeping for fear of choking. I had one horrible episode of what I believe may have been asthma attack I never had before I do not know how i even got my breath back but relaxed breathed thru nose and finally got breath back. since then no other episode like that but.. I went without sleep for 7 days due to the fear of choking again like that. Very bad experience.
Now with this proceedure i just want to know i wont be in any danger of that choke feeling, OR should i ask them for epidural can epidural be done on an obese persons?
One more thing to add is that I have an albuterol inhaler but when i have used it it has made my cough worse and dry. So i dont want to even use that for any reason.

Answer
Given your chronic history of bronchitis, morbid obesity and (?contolled or uncontrolled) hypertension I would not recommend a general anesthetic for you when a safer alternative is available: spinal anesthesia.  Also, many outpatient surgical facilities do not provide the alternative for a spinal anesthetic as it can tend to slow discharge times from the facility.

So, ask your gyn to schedule your short case in a hospital, and ask for a pre-op consultation with the anesthesiologist who will provide your anesthesia---in order to adequately review all your medical history and formulate a safe plan for your operation that is amenable to both of you.

Good luck.  By the way, it's time to have another physician look at that bronchitis, identify the cause and get it cured!