Anesthesiology/Anesthesia for upcoming surgery
First, thanks for yor help. Details 61yr old female having arthroscopic shoulder surgerysurgery with possible conversion to open. Need spurs removed, bursectomy?, repair of large, partial tear in supraspanatus, bicep tenodesis, trim SLAP tear and address possible tear in front rc
COMORBIDITIES: weight 270, height 5'6"
Mild sleep apnea
Mild asthma during spring and fall allergy seasons
Mild heart attack 10 yrs ago when mother-in-law died. Ejection fraction 38, improved to 50s, now 45 or 48. No blockage, mild cad- vasoconstriction under stress.
Cardiomyopathy - lower left ventricle
fairly reg.white sputum
hyperlipidemia/ high cholesterol
Meds: 50mg amitriptyline to help me sleep
50/125 mg losartin/hct
5 mg norvasc
150 mg ranitadine at bedtime
25 mg. exemestane chemoprevention for breast cancer
2.5 mg crestor 2x/week, do not tolerate statins well
1000-3000mg fish oil
1000 mg D3
1000mg vit C
200 mg COQ10
200mcg chromium polytinicotate
Occassionally take vit B, magnesium, selinium and a few other supplements.
If I have a choice, what would you suggest and why? I am not squeamish. I had two cataract and two total ductectomies with local and conscious sedation this past year, but realize this will be longer and more involved.
Thanks again; I look forward to hearing from you.
Thanks for your question Libby,
I assume by what I would suggest for choice you probably mean regional vs. general anesthesia?
First, for shoulder surgery, unless there is a compelling contraindication, I opt for general anesthesia with an endotracheal tube plus a brachial plexus nerve block +/- a catheter for a perineural catheter for continuous infusion.
Your heart condition, particular the vasoconstriction with stress you describe makes the nerve block more important than it would otherwise be in a patient with a normal heart. Your sleep apnea also makes a nerve block ideal as narcotic pain medications will make your obstructive episodes after surgery worsen.
A little more about the nerve block. Placing local anesthetic around the nerves that transmit pain from the shoulder can be extremely helpful after shoulder surgery to relieve the pain. Furthermore, reducing the stress response that goes along with painful surgery can help the body heal, can reduce stress on the heart which could be important if it is vulnerable to stress, can reduce the chance for blood clots, and may reduce the side effects that go along with narcotic pain medications.
While done a nerve block with sedation for shoulder surgery, this may be riskier in a patient that has OSA as the airway is not controlled and any sedation will risk episodes of obstruction and low oxygen levels during the procedure. This is particularly problematic in patients whose BMI is >30 (overweight) which at 5'6" and 270 lbs you would be at risk.
I hope this answers your questions.