As an asthmatic, I keep hearing “Ooooh, gotta avoid general anesthesia if at all possible”, and I also hear that if someone has a respiratory infection they avoid surgery also (obviously if it’s an emergency situation they just deal with it somehow).
My one real experience with general anesthesia was for nasal work, 20ish years ago, and I had no problems. Since then I’ve had nitrous oxide + Halcion (a benzo-class sleeping pill) for dental work. Mostly that’s been zero problem, but twice how when I’ve gone into it with somewhat of an increase in asthma symptoms already, I’ve had bad aggravations (as in, oral steroids required). So, lesson learned, that’s something I’ll avoid in the future by rescheduling procedures as needed.
But - what’s the mechanism? Are the inhaled gases irritating to the lung passages? is it the “lying prone for a couple hours” (you’d think not since we do that when we sleep, just fine).
And what do they do to reduce the problems if surgery has to be done anyway?
I would imagine it’s pretty common for people with asthma to have surgery so I am sure they know how to deal with it. It’s not like asthma is a rare thing.
Well, when THIS asthmatic had surgery they didn’t knock me out, that’s how they dealt with it. That, and REALLY good local anesthesia. I even related the story in a thread some time back.
I’m going to take a stab at this question, but if a real doctor comes along and contradicts me go with the doc:
Anesthesia might tend to suppress the breathing reflex, which isn’t a good thing with someone with compromised lungs who may not be getting as much O2 as they should even when awake and alert.
Some forms of anesthesia may irritate the lungs, which is annoying enough in normal people but asthmatic lungs are already irritated, so that could just make things worse.
Then there’s that breathing tube they stick down your throat and into your lungs - seems to me that could be irritating, too.
I expect it’s dealt with by avoiding anesthesia where possible, and where not, intense monitoring for side effects and exacerbation of the underlying asthma. That might me additional medications like bronchiodialators or steroids, either prophylactically or after the surgery as needed.
Asthma is primarily a disease of inflammation: Bronchioles become inflamed, and that tends to make them more twitchy, so they’re more likely to spasm. Voila, asthma attack. The spasm begets more inflammation along with more secretions, which further narrow the spasming airways.
Rescue treatment of said attack is to reverse the spasm with meds like albuterol. But maintenance therapy aims at reducing the inflammation and clearing out the secretions. This keeps the asthmatic airway on less of a hair trigger.
Come along now with inhalant gases designed to render a patient unconscious. They’re tricky, tetchy, and need to be carefully monitored even in a set of normal lungs. Airway management is Job One in the anesthesia trade. Getting a person to wake up and breath on their own and regain the normal airway-clearing reflexes after anesthesia is a big accomplishment.
Add into that the increased possibility in an asthmatic of the gases (or intubation) setting off an acute bronchospasm (which can be fatal) and/or increased inflammation, and you’ve got a big, sphincter-tightening job for an anesthesiologist.
So while asthmatics can and do have general anesthesia, most gas passers will try to use other anesthesia options where possible, and to ensure the asthmatic’s lungs are in the best shape possible before elective general anesthesia.
Thanks, all - I suspected it was something like this (combination of irritating gas and the mechanical irritation of intubation) but wasn’t sure.
With a non-asthmatic with a respiratory infection, I’d guess there’s still the risk of bronchospasm (i.e. everyone has the potential to spazz out, they just usually don’t?) Typo Knig had surgery a few years back, and caught a cold right beforehand, and there was some discussion of whether to proceed with the surgery. Ultimately they did, as he has no history of respiratory problems, the surgery was minor, and we think they didn’t actually intubate him. He was pretty thoroughly unconscious somehow, however.
**QtM **- love the description of sphincter-tightening. TV shows usually don’t show the anesthesiologist breaking much of a sweat, it’s always the Heroic Surgeon saving the day. So you’re saying they’re not entirely based on reality?
Mama Zappa- it is possible they used a Laryngeal Mask Airway- it goes into the mouth and sits over the larynx.
This is opposed to an endotracheal tube, which goes through the larynx and into the lower trachea.
Laryngeal spasm is more likely with a foreign body (i.e. a tube), but a LMA doesn’t give the nice tight seal that anaesthetists like. It’s a good option for short surgeries without deep anaesthesia.
Anyone who is unconscious needs airway protection- whether that is a simple Guedel airway to keep their tongue down, an LMA or an ET tube depends on the anaesthetist, the anaesthetic and whether the patients are still breathing for themselves- major surgeries often require muscle paralysis so machines have to breathe for you- and that needs an ET tube.
Anaesthesia can be induced very easily by injecting drugs, rather than inhaling gases, if need be. Again a preference dependent on the anaesthetist, the type of surgery, the type of patient and how quickly things need to happen.
I have one addition. While I was under they gave me some kind of medication for my cold. My cold was gone when I woke up from the anesthesia. Not just better - gone! Over the hill, gone-ski, gone-issimo! GONE My cold didn’t come back for a day or two. It was like Afrin, but without having to re-dose every 8-12 hours, and with no rebound. OMFSM, I WANT this medicine!!!1111!!! It’d probably kill me unless I was under the supervision of an entire surgical team, but it’s probably worth it. The. Cold. Was. Gone.
Maybe it’s best you don’t tell me what they used to make my cold go 'way.
FWIW I have chronic bronchitis and have had a few general anaesthesias and also lighter treatment that they said I’d probably not remember (which was true).
Several times the anaesthesiologists said they would switch to a less irritating inhalant because of this.
I’ve also had the surgeries make the bronchitis worse. A neck fusion last summer made it a bit worse, but that is to be expected at least on the basis of wrenching the neck contents out of the way to work on the spine from the front. A ganglion cyst removal from my wrist triggered a pretty bad spell of acute bronchitis, half a year if I remember right.
My cold didn’t come back for a day or two. It was like Afrin, but without having to re-dose every 8-12 hours, and with no rebound. OMFSM, I WANT this medicine!!!1111!!! It’d probably kill me unless I was under the supervision of an entire surgical team, but it’s probably worth it. The. Cold. Was. Gone.
