Anesthesiologist appointment ---- more like dis-appointment

Yesterday, I had my preop appt. with the anesthesiologist. I was given a copy of the consent for anesthesia to review. Then, I met with a PA for about an hour, going over all my current meds and answering questions about previous surgeries and such. After that, the anesthesiologist came in and handed me the consents to sign. She didn't really go over too much, other than to tell me they use Propofol to put you out. She asked me if I had questions, which I did. I asked her if she would be my anesthesiologist on the surgery day. She said no, they don't know who it will be because they have so many. Well, this answer kind of threw me off because I wanted to know about personal complication rates and such, but since she wasn't going to be the one, all those questions went out the window. I then asked what kind of pain meds I would receive. She stated that it would be either Morphine, Fentanyl or Dilaudid. She told me to ask my surgeon to find out what I would be getting. I then told her I am sensitive to narcotics, I get lots of nausea. I told her I get bad headaches with Zofran, is there something else. She said no, that I can choose between a headache or nausea, but again, the surgeon would be the one to ask. I said, ok, so basically you are telling me that I won't know anything until the day of surgery. She didn't really reply to that statement. This is not what I was expecting from this appointment. I thought I was there to meet my anesthesiologist, so that I could be comfortable with who is going to be administering these drugs. Not the case. She seemed slightly rushed, and I only spoke with her for about 10 minutes. I spent more time with the PA than the actual anesthesiologist. Very disappointed. She also said that either a nurse anesthetist or a resident will be putting me to sleep. I was very adamant that they did not allow students to push the meds (it is a university teaching hospital). They give 30 minutes to go down and 30 minutes for recovery.

I also asked about CPAP use when coming out of anesthesia. She stated that I should bring it but that they will not use it because it may stretch the stomach and suture line. They instead use some kind of nasal 'stent' that they insert while I am out, then when I wake up, they will remove it. She said it doesn't hurt when you take it out. I sure am skeptical about that, but maybe the pain meds will dull the pain. I am reliant on my CPAP; I cannot sleep without it. If I happen to fall asleep without it, I wake up gasping for air. My PCP said that I have the worst case of OSA that she had seen in her 20 yrs. experience working with OSA patients (130-160 episodes a minute - doesn't seem possible, but it is true!) I am worried that I won't be able to sleep or if I do fall asleep, that I will stop breathing. Worst fear - surviving the surgery and dying afterwards because I can't use the CPAP. I do know that because of my high pressure (20), I swallow air. I sure don't want to burst my new stomach.

I left the office with more questions than answers. I felt that the appointment was merely a formality. I really expected more from a Center of Excellence. This hospital is the best one around (Penn State Hershey Medical Center) and it has the latest technology and supposed to have the best doctors. Why do I feel shortchanged?? It doesn't help matters that I am already on the fence about going through with the surgery. I was hoping to feel better - more positive and comfortable with the whole procedure. Nope.

The only thing that keeps me sane right now is the fact that I know they don't want me to die - it would ruin their reputation :)

Hi Angelina,

I'm just writing to try to calm your fears.  You yourself said that this is one of the best hospitals around.  ALL their anesthesiologists are good.  You wouldn't want to be held up waiting for one specific anesthesiologist, if he or she is stuck in a surgery that is taking longer than expected, right?  The residents are all excellent, too, and there will be plenty of supervision of them.  Your severe OSA is in your file, and if they think it could potentially complicate anything they will prepare themselves.

 I don't know if OSA interferes with being under anesthesia, but if it does then maybe that could possibly trigger extra observation, or a requirement that students can only observe and not have a hand in your care?  I'm just guessing here.   I don't know hospital procedure but it seems to me that if your medical history indicates that you might have a difficult time in surgery, they would assign medical staff that would be best able to care for you.

The questions about medication should probably be directed to the surgeon instead of the anesthetist.  And maybe she didn't have the best "bedside manner", but that doesn't mean she isn't going to be good at her job.  I prefer doctors who seem more focused on their abilities than being friendly with their patients, it's just something I'm used to.

Just trust that you will be in good hands!

Also hoping to ease your mind, I have had over a dozen surgeries in the last 10 yrs and not once did I meet my anesthesiologist until right before surgery and mine was also a Center of Excellence. Write yourself a note of a few of your most pressing questions or ones your surgeon doesn't have answer for and take that with you to tell the anesthesiologist. That's what I do because I get nauseous and have a lung disease so I make sure they are aware of that. They will have you on oxygen during and probably after surgery so you may not need the CPAP some surgeons have you bring them with you and some don't.

Even if you have to choose between a head ache and nausea at least in the hospital they can give you good pain meds for the head ache. These are all things you can ask your surgeon before you even go to the hospital. Are you able to contact your surgeon by e-mail? If so that would be the best way to get answers before surgery unless you can get an appt with him. Like you said they really DO want you to come thru with no problems, just think of all the paperwork they'd have to do if there was one, nobody wants to do that! Try to relax and maybe practice some relaxation techniques until then. Best of luck to you!!!

In terms of not being able to breathe after because of your apnea, I just wanted to reassure you that they will have that oxygen monitor on your finger, and if it drops, all the beeping will commence and they will take care of you right away.  In recovery, you have one on one supervision by a nurse until you are fully awake.  I never even met my anesthesiologist, only the nurse anesthetist, and I was at a center of excellence also.  They still took great care of me.  You can do this, and you will do great!

I live in Pennsylvania, so I do know that PS HMC has a good reputation in certain areas. I have heard from a couple of bariatric surgery patients that communication can be a bit frustrating with them though. I went through Geisinger and had a great experience; however, I didn't even meet the anesthesiologist at all, so I can't be much help here.

If you still have burning questions though, I would keep asking them. You have to be your own advocate when it comes to your healthcare!

I am having RNY this coming Wed. At Columbia Presbyterian Hospital in nYC. I am high risk with both Cardiac and breathing( Lung) problems. In addition, although I do not have sleep apnea, the sleep study determined I have Hypoxia in REM, meaning that my oxygen level drops as low as 74 during dream sleep, and hovers about 80 when I sleep. I use oxygen every night.

at my final surgical consult my surgeon told me she would use oxycodone and morphine for pain relief, and I told her that the morphine pump after my last surgery was useless. She ordered dilaudid for my pain pump and gave me a prescription for them to use at home. More to your question, my surgeon asked me if I wanted pre surgery anesthesia consult. I said yes. When I went for my final pre op tests last week, they asked if I wanted to do the pre surgical consult that day, or wait to meet with my actual anesthesiologist the day of the surgery. They told me if I met that day with someone they probably not be the anesthesiologist for my surgery, and then I. Old not have another consult the day of. I elected to wait. I cannot imagine that they would do surgery on a high risk PT like you( or mr) without meeting again the day of surgery. I also had to sign for the use of interns and for the use of video and the presence of vendors in the OR. Got the feeling that I could opt out but I chose not to.

Thank you all for reading my book! LOL! I appreciate you taking the time to respond with positive feedback and concern. I will be meeting with my surgeon on Dec 4th, so I will be able to have her answer some of the most pressing questions. I am very comfortable with her so I'm sure she will be able to give me the answers I need.

I spoke with my surgeon about the pain meds. I have severe anaphylaxis when I take opiates. He made sure he had a good pain med all ready for me. In the hospital I didn't have a lot of pain. On a scale of 1-10 I was a dull 6 at most. So I switched b/t Tylenol and Motrin. Upon discharge he wrote a script for Nucynta for pain (75 mg). Truth be told, I took 3 of those pills and that was it.

Do know that all involved want the best outcome for you. But do make sure you are at peace before heading in. Best wishes for you!