Anesthesia

[DinkyB]

Will try to keep brief. I'm dx'd with mild-mod Emphysema. Went last week for minor out-pt. surgery; knee scope. Went in afebrile, Sats 98%. Lungs clear as a bell.
While in recovery, my O2 sats dropped to 40%, I went into sinus tachycardia, spiked a 102.7 temp and for 3 days was coughing up a foamy, bloody sputum. It tasted like blood. It later turned dk. brown, then yellow. I ended up in the hospital on oxygen and telemetry. They did blood cultures, sputum cultures, etc. The temp subsided by day 2. On room air by day 4. The sinus tach subsided by the 4th day post-op.
My question: What the heck happened to me? Do I now need to be worried about my heart as well as my lungs? I had 5 doctors, but not one of them seems to agree on what caused this episode. Or at least they will not let me in on what happened. My surgeon said he felt maybe I had aspirated. The other docs say no. I have worried about CHF as it is in my family hx and due to my COPD. It really scared me and I feel thankful to be alive and breathing. I am still very congested. I'm on a 40 mg Pred burst, Levaquin, Advair, Spiriva, Singulair. Can't seem to get to the clear state I was as before. X-ray showed no pneumonia, no blood clots etc.
Any opinions?
Many Thanks,
DinkyB, MO

[National Jewish]

I agree with your surgeon that you probably aspirated.  This could have caused aspiration pneumonia.  This does not sound like congestive heart failure (CHF).  It was not caused by your COPD.  For another opinion about what the heck happened to you check with the anesthesiologist.

[Ellis7]

Sounds like it could be Aspiration Pneumonia. Did you have anything to eat or drink, other than sips of water, in the 12 hr before the anesthesia? Link at:
http://www.emedicine.com/EMERG/topic464.htm
Aspiration Pneumonia
Excerpt:
"Causes: Conditions that may reduce a patient's gag reflex and/or ability to maintain an airway include aspiration as a coincident risk.

Drug and/or alcohol ingestion (includes drugs used for general anesthesia or conscious sedation)"

[DinkyB]

I was cut off food @ 10:30pm Wed. Surgery was 0810am Thursday. I went and read on aspiration pneumonia. I'm sure that is what it was, but my doc still says no as late as today. I went to the doctor today, with a temp of 99.4. That convinces me even more that I have aspiration pneumonia. I could be wrong, but....
Maybe it does not matter that I know, but I don't like not knowing. If I did aspirate, was it so tramatic because of my lung situation (Emphysema) or would it have been the same anyway?
If it was not aspiration, what would cause my sats to drop to 40%? What would cause a spike in temp? Further discussion welcome:).

Thanks for your reply.

DinkyB

[Ellis7]

The important thing now is what is your diagnosis and what is the appropriate treatment. If it is Aspiration Pneumonia [as your surgeon suspects] the appropriate treatment is penicillin or clindamycin antibiotic, see the website above. I was dx'd with Aspiration Pneumonia and was treated for 4 weeks with clindamycin [I'm allergic to penicillin].

If you have GE reflux, it could continue to irritate the lung and prevent it from recovering. In that case you should have treatment which can include:
*no meals near bedtime
*tilt head of bed up 6" with wood blocks or better use a medical wedge, like a MedSlant www.medslant.com [I use one of these]
* drugs like omaprazole

[AndyRRT]

This could be a combination of things. Asperation pneumonia doesnt cause bleeding, or frothy secretions. But it can cause the temperature and alterations in oxygen saturations.

Generally, surgeons LOVE to hydrate their patients. Always-always-always. They give free fluids via IV. In some case, patients that have relatively weaker hearts, will go into what we call pulmonary edema. (CHF) Their bodies just cant handle the extra volme and it eventually leaks into their lungs causing the frothy sputum.

Aspiration can also happen just before intubation, during the procedure, and after extubation.

Andy, RRT, CPFT.

[DinkyB]

Thanks Andy and all,

Andy, I am going to a new pulmo the 7th of July. Is this something you think I should press? Should I request any kind of cardiac testing? Should I want to know more? Or should I just thank God I'm alive and well and let it go? The nurse (jokingly, I think) said "No more out-patient surgery for you".
Being I am going to a new guy, I don't want to give the impression I am a nervous nellie. I kinda am. (I told everyone before my surgery my only worry was I would not survive the anesthesia as this was my first time being anesthetized since my lungs went bad). But overall I was really pretty confident that all would go fine. I want him to feel comfortable about keeping in the loop of knowledge.  
However, I don't want to blow off getting something checked out just so I don't appear obsessive. I value your advice and appreciate the time spent giving it.
Thanks bunches and bunches.
DinkyB

[AndyRRT]

Dinky,

BEfore you see your new physician, start a journal of notes. Start this NOW. Write down anything and everything you can think of regarding your pulmonary history. Starting with smoking history, exercise tolerance, triggers that may make you wheeze, weather tolerance, allergies, sleeping habits, (ie needing multiple pillows behind your head) Write down all your meds, past and present. Write down those meds that have had good effect on you. Tell him about any hospitalizations you've had, etc.

The more your NEW doctor knows about you, the better. The more you know about your condition, the better you can handle exacerbations! I am a total advocate when it comes to patients asking questions to their care takers. Sometimes care takers can just throw out jumbled and confusing information. The worst thing for a patient is not knowing what is going on with their bodies.
So on July 7th, make sure your doctor knows as much as possible. And make sure you UNDERSTAND the things he tells you. If you dont, ask him to re explain it.

As far asking for cardic work up, that will be upto your doctor to decide.

Goodluck, and keep us posted.

-Andy, RRT, CPFT

[DinkyB]

Thanks for the advice. This is a great site. We are blessed to have it and all your knowledge.

DinkyB

[DinkyB]

Dear NJC-R.N.-DC,
Thanks for your response to my question.I ws scared about my heart now becoming an issue. Thanks, too, for throwing in there about it not being caused by my COPD. For two reasons. Here I was again feeling guilty thinking perhaps it had happened because of the COPD that I feel responsible for because I smoked. Also, I was concerned that my COPD had hit a new level. Maybe I was getting worse and didn't know it. In any event, you have put my mind at ease.
Blessings to you,
Lynette

[ehaceh]

A related discussion, post Aeneasthetic pulmonary oedema was started.