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Anesthesiology/Anesthesia for upcoming surgery

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Question
First, thank you for being so gracious to answer questions for patients with concerns.  I am a 61 yr old female who is going to have arthroscopic shoulder surgery next month with possibility of converting to open and would like to know the best type of anesthesia given the following surgical needs to be addressed and the comorbidies that I have.  My shoulder needs to have bone spurs removed, (don't know if bursectomy or partial will be involved), repair large partial tear of supraspanatus, bicep tenodesis, trimming of SLAP tear, and there may be something that needs to be cared for in tendons that attach in front.  

Unfortunately, I weigh 270 and am 5'6"-obese tall--obese
Hypertension
Hyperlipidemia/highcholesterol
Predibetic
Had minor heart attack 10 yrs ago when mother-in-law died(mild narrowing, no blockages-vasoconscriction- ejection fraction was 38, improved to 50s, now 45and or 48
Mild sleep apnea
Mild asthma during spring and fall allergy season
Have fairly regular production of white sputum
Cardiomyopathy-damage to lower left ventricle

In addition, I take 50mg amitriptyline to help me sleep and the following prescription
3.75-5mg bystolic
50/12.5 mg losartin/hct
5mg norvasc
150 mg ranitadine at bedtime
25 mg exemestane chemoprevention for breast cancer
2.5 mg crestor/week, do not tolerate statins well

1000-3000mg fish oil
1000 mg D3
1000mg vit.C
200mcg chromium polytanicate
200mg COQ10
I occassionally take a few other supplements like vit.B, magnesium and selinium.

If I have choices, what would be the best anesthesia for this surgery and why.   I am not squeamish and had two cataract surgeries and two total ductectomis this past year under local with MAC.  However, I realize this surgery will be longer and more involved.

I look forward to hearing from you.  Thanks again for your consideration.

Answer
It's not too often someone on this forum provides an adequate medical history and pertinent facts relative to their health status.....THANKS!!!  You've asked an important question that all surgical patients should be asking prior to their surgeries.   Currently, most of us agree that the best way to proceed is with a supraclavicular nerve block to the brachial plexus (the group of nerves that come out of your neck and go to your shoulder and arm).  Blocking (injecting numbing medication like novocain) the brachial plexus will make the shoulder numb to pain;  you'll also be anesthetized with  a general anesthetic as well, but with the block in place FIRST, AND BEFORE YOU GO INTO THE OR, you will require less general anesthesia and therefore less stress on your heart.  The shoulder will also be numb long after the surgery, so the block will provide good post operative pain relief for the first day or so afterwards.  Meet with the anesthesiologist a few days before the surgery, so you can ascertain that this will be the plan: OR's are too hectic with serious time constraints these days to try to get all your questions and options discussed the day of surgery.

Anesthesiology

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JM Starkman, MD

Experience

Over twenty-five 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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