Or at least the safest? I have to have surgery and know that you did a lot of interviewing and research on this topic....
Many thanks, feelfit
Posted by Lauralyme (Member # 15021) on :
If it's on your lower body perhaps an epideral
Posted by Hoosiers51 (Member # 15759) on :
I will PM these to you too, but here are some links someone sent me. Didn't have time to read through them again now, but I remember they were very helpful:
Here's something from the first link. If you notice, it lists Propofol (Diprivan) and Fentanyl as being generally well-tolerated. Tell them you don't need a sedative to be given to you before they wheel you into surgery. They usually give people something to make them groggy, so they don't freak out when they see the surgical tools.
But I told them that step was not necessary, and getting wheeled into the room didn't scare me at all actually. I was conscious for like 30 seconds, until they give me the anesthesia in the surgical room.
Everything turned out just fine. Recovered very quickly. Can't remember what I got exactly, but it turned out just fine and I didn't even feel groggy afterwards. Most of the drugs they use nowadays in surgery are well-tolerated. They don't use the fat-soluble anesthetics much anymore, from what I understand. Those are the bad ones.
Here's some info from that link:
Recommendations For Persons With CFS Or Fibromyalgia Who Are Anticipating Surgery CFS is a disorder characterized by severe debilitating fatigue, recurrent flu-like symptoms, and neurocognitive symptoms such as difficulties with memory, concentration, comprehension, recall, calculation and expression. A sleep disorder is not uncommon. All of these symptoms are aggravated by even minimal physical exertion or emotional stress, and relapses may occur spontaneously. Although mild immunological abnormalities (T-cell activation, low natural killer cell function, dysglobulinemias, and autoantibodies) are common in CFS, subjects are not immunocompromised and are no more susceptible to opportunistic infections than the general population. The disorder is not thought to be infectious.
Persons with CFS frequently re-activate latent herpes group viruses, which may produce a mild, subclinical hepatitis with slight elevations of the transaminases. Thus, hepatotoxic anesthetic agents should be avoided because they could potentiate the liver problem or even provoke fulminant hepatitis.
Intracellular magnesium and potassium depletion has been reported in CFS. For this reason, serum magnesium and potassium levels should be checked pre-operatively and these minerals replenished if borderline or low. Intracellular magnesium or potassium depletion could potentially lead to cardiac arrhythmias under anesthesia.
Up to 97% of persons with CFS demonstrate vasovagal syncope (neurally mediated hypotension) on tilt table testing, and a majority of these can be shown to have low plasma volumes,low RBC mass, and venous pooling. Syncope may be precipitated by cathecholamines (epinephrine), sympathomimetics (isoproterenol), and vasodilators (nitric oxide, nitroglycerin, a-blockers, and hypotensive agents). Care should be taken to hydrate patients prior to surgery and to avoid drugs that stimulate neurogenic syncope or lower blood pressure.
Allergic reactions are seen more commonly in persons with CFS than the general population. for this reason, histamine-releasing anesthetic agents (such as pentothal) and muscle relaxants (curare, Tracrium, and Mevacurium) are best avoided if possible. Propofol, midazolam, and fentanyl are generally well-tolerated. Most CFS patients are also extremely sensitive to sedative medications -- including benzodiazepines, antihistamines, and psychotropics -- which should be used sparingly and in small doses until the patient's response can be assessed.
Finally, HPGA Axis Suppression is almost universally present in persons with CFS, but rarely suppresses cortisol production enough to be problematic. Seriously ill patients might be screened, however, with a 24 hour urine free cortisol level (spot or random specimens are usually normal) or Cortrosyn stimulation test, and provided cortisol supplementation if warranted.
Summary Recommendations:
* Avoid hepatotoxic anesthetic agents
* Insure that serum magnesium and potassium levels are adequate
* Hydrate the patient prior to surgery
* Use catecholamines, sympathomimetics, vasodilators, and hypotensive agents with caution
* Avoid histamine-releasing anesthetic and muscle-relaxing agents if possible
* Use sedating drugs sparingly
* Consider cortisol supplementation in patients who are chronically on steroid medications or who are seriously ill.
Relapses are not uncommon following major operative procedures, and healing is said to be slow but there is no data to support this contention.
RECOMMENDATIONS BY PAUL CHENEY MD AND PATRICK CLASS MD The following two quotes appear frequently throughout the CFS/FM/MCS support group and website literature:
"I would recommend that potentially hepatoxic anesthetic gases not be used including Halothane. Patients with Chronic Fatigue Syndrome are known to have reactivated herpes group viruses which can produce mild and usually subclinical hepatitis. Hepatotoxic anesthetic gases may then provoke fulminate hepatitis. Finally, patients with this syndrome are known to have intracellular magnesium and potassium depletion by electron beam x-ray spectroscopy techniques. For this reason I would recommend the patient be given Micro-K using 10mEq tablets, 1 table BID and magnesium sulfate 50% solution, 2cc IM 24 hours to surgery. The intracellular magnesium and potassium depletion can result in untoward cardiac arrhythmias during anesthesia. For local anesthesias, I would recommend using Lidocaine sparingly and without epinephrine."
Paul R. Cheney, MD, PhD, 1992 P.O. Box 3218 86 Keelson Row Bald Head Island, NC 28461 910-457-7133 910-457-7136
"Suggestions on anesthesia include using Diprivan (propofol) as the induction agent along with nitrous oxide and isoflurane (Forane) as the maintenance agent. The ones to avoid are histamine releasers that include sodium pentothol as well as a broad group of muscle relaxants in the Curare family, including Tracrium and Mevacurium."
Patrick. L. Class, MD, 1996 Anesthesiology 300 S. Arlington Avenue Reno 89501 775-348-1900 FAX: 775-348-1912
RECOMMENDATIONS BY MICHAEL J. ROSNER MD Probably best known amongst PWCs/FMs for his identification of craniovertebral stenosis (creating a malformed or abnormally small opening of the spinal canal, known as the Chiari formation), discusses the importance of the patient's posture during the surgical procedure:
"For those patients with canal stenosis or hypoplastic posterior fossa, the most important component of anesthesia is a neutral neck position and avoidance of hypotension. The former may increase cord compression and the latter may decrease blood flow to the spinal cord. Together, the effect may be severe. This may also be part of the mechanism by which both surgery and trauma are linked in some individuals to the development of their FMS/CFS. I doubt that the specifics of different anesthetic regimes will matter too much beyond the above."
Posted by Pinelady (Member # 18524) on :
All great info. I suggest talking with your
anesthetist. Tell him everything. He is the one who
will be taking care of your body while the surgeon
does his job. Don't dismiss any allergies, list all
meds taken within the last 3 months, and any
concerns ask. Prayers for a great outcome.
Posted by feelfit (Member # 12770) on :
Many thanks to Hoosiers and Pinelady.
I appreciate the links as well....
Ff
Posted by Ocean (Member # 3496) on :
Feelfit,
I don't have any info for you, but wanted to say I will be thinking of you. I had surgery for ruptured appendix back in 2000, was out for an hour and 45 mins and did GREAT! I also was not groggy at all, I assume they used propofol because the half life is so short, and I was literally alert and oriented as they were wheeling me out of the surgery room. The whole Micheal Jackson thing was because he was using it to sleep at night and the doc wasn't an anesthesiologist! I would feel completely fine with propofol again for surgery.
Take care, Ocean
Posted by feelfit (Member # 12770) on :
Thanks Ocean sweetie. I will talk about this with my doc and anesthesiologist.
Ff
Posted by orrn (Member # 6672) on :
feelfit I am an operating room nurse and have been in the OR for over 11 years. I would be happy to
answer any questions I can. Please feel free to email me privately. Good luck and take care!