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Thursday, July 31, 2014
PCA pump and severe sleep apnea
Hello. I will be having a uterine fibroid embolization procedure. I have sleep apnea. I am 100 pounds overweight. I have no cPAP because it was stolen. I am worried about the fentanyl they will give me during the procedure, and about the PCA morphine after the procedure. Can you recommend a safer medication for post- surgery pain that is moderate to severe? I am afraid of dying from narcotics. What else could be used for concious sedation besides fentanyl that is safer?
Opioid medications, like fentanyl, impair breathing in normal people even in small doses. Persons with obstructive sleep apnea are especially prone to the effects on breathing of these very useful pain killers. This is less of a concern during a procedure than it is during the recovery phase. During a surgical procedure, while under the care of an anesthesiologist, slowed breathing or obstruction of the airway can be detected, prevented or treated. The problem is afterward when the effects of the drugs linger, but nobody is around to detect a decrease in breathing or partial or complete obstruction of the air passages. In this situation, if opioids cannot be avoided, it may be necessary to keep the patient in hospital for proper observation and monitoring.
Additional oxygen may be helpful, though oxygen by itself does not prevent the air passages from blocking off or carbon dioxide from accumulating in the body. A CPAP device helps to prevent sleep apnea and this treatment may be life preserving in certain situations. Alternative pain medications include non-steroidal anti-inflammatory drugs (NSAIDs) and local anesthetics, but it's not always possible to use these in all situations. Embolization procedures may produce little or no post-operative pain, so it might be possible to avoid opioids. Please check with your anesthesiologist before the procedure.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University