Mild Sedation+No liquidsx6hours

[mtgardner]

I am going to undergo a simple upper endoscopy on Monday.  The GI doctor said I was not to have liquids for six hours before the procedure and would be given sedation.  He said I would not need entubation and an anesthesiologist would not be present but that I would not be awake. He also said I would be in recovery for about an hour and I would need someone to drive me home.  I told him I have pure autonomic failure and I saw him type it into the system but I am not at all sure he knows what it means as far as symptoms.  

My question is should I request anything special.  Will they give me water in the recovery room?  I am worried my BP may drop from the dehydration alone.  Marie

[Heiferly]

Marie,

I'm hopping off to bed but just wanted to pop back in to this thread and say I'm thrilled to hear that you did well.  :-D  

Rest up!!
-H.

[tonyad]

   So GLAD to hear all went well :)

   I kinda figured like I had said....You would probably have to educate them :0
glad it's over and the test itself did not find any ill findings.

Rest,
~Tonya

[mtgardner]

I am exhausted from the long day but wanted to let everyone know that I did pretty good during the endoscopy.  They did give me IV fluids immediately before sedation and during the procedure and gave me oxygen too.  They gave me a print out of my BP but I think they only printed out one every 5-6 minutes. Of those I saw the systolic  ranged about 50 points but during this time the diastolic only varied 5 points.  When the BP was at it's lowest the oxygenation was down about 4%.  I am glad it is over.  The nurse did say she never heard of PAF so I just emphasized the need for adequate hydration and monitoring.

Thanks again for all your advice.  Marie

[mtgardner]

Beema 36 ...Thanks!  I am just getting ready to travel as it is a four hour round trip into another state for this little procedure so even our dogs are riding along.  I am hoping too this is a quick procedure with no surprises or complications. It is nice to have so many positive thoughts!

Tonyad...hope your MS exacerbation is at it's end!  Then hope the AD settles down.
You need a nice interlude with nothing flaring.  Let's hope for that.  :)  Marie

[tonyad]

   Yes!  I guess we were definately up way past our bedtime :)
I actually made myself get up and come down stairs because I am in the ending stage (at least I hope) of an MS exacerbation....Which of course wakes up the AD even more....Lol

~Tonya

[beema36]

Marie- Dont have anything to add to all this excellent advice just want to say my thoughts and prayers will be with u:)
Beema

[mtgardner]

Heirfly you are a true friend and thanks for all the concern.  I understand since I have not had this diagnoses for long I could well not get all of  my ducks in a row as is needed for simply not understanding what I should be asking them to have prepared.  What sounds simple could turn complex.  I will make sure all with me understand what could happen with pulse and BP and ask that they keep in mind they might need to act quickly and fetch an anesthesiologist if needed.   Having the affiliation and close proximity to the hospital puts my mind at ease as well.

CHRISTYDRAKE, thanks for sharing your son's experience.  This reconfirms for me what others have said about hydration.  I should ask for more then usual and ask for it in recovery as well.

I remember years back before my official diagnoses having surgery and having them call a code.  My BP dropped  and they rushed me to the  scanner on a gurney to see if I had internal bleeding.  No one ever figured out why all this happened but I am sure in retrospect that my BP was already starting to show signs of instability because of the coming dx of PAF.

[CHRISTYDRAKE]

When my son had his endoscopy and colonoscopy in Cleveland, he had an IV of fluids started before the procedure.  When the anestesiologist(sp) asked what he was having done and what was going on with my son and we mentioned he had POTS, he immediately told the nurse to turn up the IV.  He wanted him hydrated.  They also explained that my son's heart rate could drop during the procedure, which it did-down to the 20's, and what they would do if that happened.

This was done in a hospital, not an outpatient facility.  Everything was fine, so I guess the key is hydration.

[Heiferly]

Marie,

I feel a lot better knowing that you're going to be right near the hospital!  They can always move you from that building to the hospital in a jiffy if they need to, which at least in my mind eases the concerns I had, especially as it's affiliated with the hospital. Thanks for replying so I'm not sitting here worrying about you, LOL!

I think you will do fine with the procedure.  I'll look forward to an update hearing that everything went smoothly for you.  :-)  Drink, drink, drink and take it easy for a while until the anesthesia stuff gets out of your system!

-Heiferly

[mtgardner]

I appreciate all the points you have made here .  All are important points to be sure.  I will  make sure something is set-up for fluid replacement and the monitoring.  I do know that anesthesiologists are nearby tho not  involved in my procedure.  This is an ambulatory surgery center affiliated with and directly across from a major hospital....   ...which I know is not as good as being inside the hospital itself but hopefully will work for this.  Next time I should make sure procedures are in house for sure. I am just in unknown territory so to speak as I haven't had a procedure like this since diagnoses.  This procedure is already scheduled for noon on Monday so I really can't cancel now.  I can however take all of your good advice and apply it to my next procedure including the timing of future procedures in the mornings.  Makes the most sense to me as afternoons are harder for me BP wise anyway as well as energy wise.  Appreciated the comment too about how many bags of fluids it can take and that it should reflect BP after walking as well.  This has been very helpful...and I do understand all the disclaimers... There is no reason to re-invent the wheel here when you and others have had experiences that can help me make more informed decisions.  Thanks for that!  
You took the time to share a lot and I do appreciate you..Marie

[Heiferly]

Here is my standard disclaimer; you know the drill.  I am not a doctor; this does not constitute medical advice.

Marie, generally speaking, as far as I know, it is not advisable for patients with all but perhaps the most mild cases of dysautonomia to have an upper endoscopy in an outpatient facility.  PAF is not, as I'm sure you're aware, a "mild" form of dysauto.  You have not specified whether this is scheduled for an outpatient facility or for a hospital ward, but it raised a red flag for me because it sounds typical of the way the procedure *can* be done in an outpatient facility.

If this is scheduled for an outpatient facility, I personally would recommend, as a *friend* (NOT a doctor, phew, can I say that enough to be legally safe, hehehe?) that you strongly urge this doctor to cancel the procedure and reschedule the same procedure to be performed in a hospital.  The procedure itself is okay.  It is normal to be instructed NPO (no food/liquids) for hours before the procedure.  For dysautonomia patients, it is optimal that the procedure be scheduled FIRST THING in the morning so that this will mostly coincide with when your body is already accustomed to not getting fluids (when you are sleeping).  They should give you the earliest procedure slot they have in the day (often something like 8 AM, and yes, it will be not fun having to check in at the hospital so early).  They should say it is OK to take tiny sips of water as needed to take any essential meds (such as midodrine, fludrocortisone, whatever are your big important ones that you might normally take during the hours when you're going to be on the no-fluid-intake time).  You can postpone any non-time-dependent or non-essential stuff like vitamins, and they will probably ask you not to take blood thinners/aspirin and maybe some other things so ask about that.  

The type of sedation they are describing is "twilight anesthesia."  You will be awake during the procedure, but sort of "out of it."  Most people get amnesia from twilight anesthesia, so that when they come out of it, they can't remember whatever occurred while they were "under."  It usually includes medication to lessen pain/discomfort and the medication to make you semi-sedated/have amnesia later.  Usually that medicine is a drug called Versed, but there are others.  You will be able to indicate during the procedure if you are under distress, and they can give you additional medication to make you more comfortable.  

In addition to requesting that you have the procedure done in a hospital, I would request that they plan IN ADVANCE to give you IV hydration in recovery.  They may try to tell you that that will be available "if needed" and can be handled at the time, but again, as a *friend* I'm telling you that I would be rather adamant in my request that this be planned for in advance because you're not going to be in a position to advocate for yourself when you're coming out of twilight anesthesia.  Your doctor will not be present in recovery, and I've found it's not particularly easy to convince the people there of what your doc promised you earlier (that's not their standard protocol).  You should also double-check that they will be monitoring your HR and BP throughout the procedure, as should be standard for anyone with dysauto (not sure if this is standard for people without or not, LOL).  Also, I've been surprised to see here in our community that some people are getting 1 bag of IV saline at the hospital and considered "tanked up" without any checking to see how much improvement they've actually made.  They should definitely judge how much you need by your BP readings.  You know what is normal for you, so discuss this in advance with the doc so you can agree upon how hydrated you need to be to be sent home.  It might take 3 liters to get you comfortable enough, it might only take one.  In my experience, the real test is a cross between comparing my lying down/sitting/standing BPs to how I feel when they get me up and walk me around a bit.  If both of those check out, then I'm "tanked up."  I don't think it's ever been the same number of IV bags on two consecutive trips to the hospital; it just varies that much.

You will be allowed to drink water in recovery as soon as they are confident that you are awake enough not to choke, which is pretty much as soon as you are awake enough to know what's really going on anyway.  

I hope that helps and doesn't scare you or anything.  I've had I think 3 of them ... it's pretty routine, just definitely better done under a hospital roof in my opinion just in case anything should go awry.  I don't think outpatient facilities are equipped to handle as many things if something should go funky with the dysauto.  One note:  no one here has reported a problem with their dysauto under twilight anesthesia as long as I've been on the forum, so I hope that eases your worries some!

[mtgardner]

Hello  again tonyad,

It is always good to see you here. Thanks for your very thorough response.  It is helpful to know what to expect and puts my mind at ease.  I will tell them when I go in how hydration of lack thereof effects my BP.

Also thank you for your quick reply.  We are both obviously up past our bedtimes. ;)  Marie