Expert: Jennifer Evans, MSN, CRNA - 12/14/2011

Question
My grandma has lumbar stenosis and is in severe pain for the last two months.  Her doctor tried themeducation route and not even Morphine IV works anymore.  She's in the hospital right now and they can't manage to control her pain.  They want to do an MRI but she cant even lie flat.  The doctors say she needs anesthesia for MRI and also surgery will be the only thing that canposdibly relieve her pain.  But there's a high chance she won't tolerate anesthesia and will have a tune for the rest of her life because her copd and CHF is severe.  We don't know what to do.  She can't live with the pain and she can't live witha tube for the rest of her life.  Do we have options other than GA and intubation for MRI and Laminectomy?  Btw she is on oxygenate home 24hrs. and does not tolerate any activity at all.  She also has DM type II.  Please help.

Answer
Hi Lyn,

General Anesthesia with an Endotracheal tube would be needed for the Laminectomy.  She would be laying face down for a prolonged period of time and with her history, a secure/safe airway, as well as medications for paralysis during the surgery is needed.  Since she is on Home Oxygen and cannot tolerate any activity, including lying flat, GA is most appropriate for the MRI as well.  They need her to be motionless for 30-45 mintues for good pictures. With a breathing tube the anesthesia provider can give her adequate breaths while lying flat. Her pain while lying flat can be controlled with GA as well.

I'm sorry that I do not have a different answer for you.  Have they tried cortisone injections for pain?  Have you considered the option of a spinal cord stimulator for pain, before undergoing a laminectomy? We frequently do spinal cord stimulators at Hopkins.

Have you thought about going to Johns Hopkins since you live in Pennsylvania?

Also see if they can schedule the MRI followed by the back surgery so that it is one anesthetic for her.  Patients with Severe COPD/CHF do get extubated in the ICU after a few days of pulmonary workouts, but without knowing her lung function numbers or CHF markers, I cannot give you any sort of prediction.  If patients have prolonged need for a breathing tube, there is the option for a tracheostomy as well and that should be discussed with her and your family.  She may still have a need for a chronic ventilator even with a trach.

Good luck!!

Jennifer, CRNA