Expert: Ronald Levy, M.D. - 6/15/2007

Question
I am 42 yrs old and have been dx'ed with a myopathy with proximal and respiratory muscle weakness. I am concerned if I have to undergo general anesthesia that there may be problems with extubation in regard to the weakness. My PFT's reveal a restrictive process with MVV 31%,MIP 21%, and MEP 25%. I also have early signs of an interstitial lung disease ( interstitial changes both bases on HRCT and interstitial prominence on CXR).
If I had to have general anesthesia, are there certain meds or things that may help prevent extubation problems? I am terrified of waking up intubated ( I have had that happen a couple times after surgery because I was too weak to extubate) and being on the vent. Also, would IV sedation also be a risk ( not as great as general, I know)? Should an anesthesiologist or CRNA be present for IV sedation instead of just a nurse for those type of procedures done with IV sedation?
As a former PACU RN , I know there are risks but would like to minimize them if possible.
Thanks for your help.

Answer
There really are no medicines that would reduce the risk of prolonged intubation. The biggest factors are the length of surgery, type of surgery and fluid administration. I think that you are at high enough risk to warrant an anesthesiologist for any procedures requiring DEEP sedation. You would also be advised to try to have regional anesthesia whenever possible. As for waking up with the tube, if they keep you well sedated, you would only be uncomforatble as they were trying to wean you.

Good Luck,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston