asthma and surgery

[mindyrk]

Thank you for taking my question.
I have had asthma since I was young that has rarely given me problems until this last year.  I had surgery (gallbladder) in March and since that time I have had to more than double my medication and have been on short bursts of prednisone (7-10 days) 6 times since march. the last time I was on Prednisone was in early October. I also take advair 250/50, singulair 10mg, flonase, and clarinex 5mg.  I am currently using my albuterol inhaler on average of 1-3 times a day and 1 time at night about 3-4 times a week.
My questions are:  Can surgery bring on problems with asthma?
Is there anything you can do to prevent it?  I have to have surgery on my shoulder in December and I am worried about my asthma getting worse.   the last time my asthma flared up (october) I had to have a decadron shot, and take 120 mg of prednisone, I missed several days of work and was almost hospitalized.  Is there anything you can recommend to make the surgery and recovery easier on asthma?  Any information you can give will be appreciated!
Thanks for your help!

[National Jewish]

It is the general anesthesia that is used for surgery that can bring on problems with asthma.  With good asthma treatment, like you are getting, the problem should gradually resolve over time.  The cause is not always clear.  Apparently some anesthetics are more prone to do this than others.

Try contacting the anesthesiologist who gave the anesthesia in March 2004.  Let this doctor know what occurred.  Ask if any of the anesthetics used have been reported to worsen asthma.  Then ask if another anesthetic or class of anesthetics should be used for your surgery in December 2004.

[Ellis7]

For asthmatics, its generally better to avoid a general anesthesia with intubation if possible; ask your surgeon and anesthesiologist if a regional anesthesia could be used. See:

http://www.shouldersolutions.com/surgery_1.php
Choices for Anesthesia
Excerpt:
"You have essentially two choices for what type of an anesthetic to have during shoulder surgery: a regional or a general anesthetic..............

Regional anesthesia involves having your anesthesiologist perform a procedure called a "nerve block", where medications are injected in the area around the nerves that travel to the part of your body that is being operated on. The most common type of regional anesthesia that is used for shoulder surgery is called an inter-scalene block. This type of anesthesia is administered just before your operation.

In contrast, a general anesthetic involves going to sleep. In this situation, your anesthesiologist will give you medications that will completely relax your entire body and stop you from feeling any pain. During general anesthesia you will need to have a machine breath for you by gently pushing air into your lungs through a tube in your throat. This most commonly involves placing an "endo-tracheal" tube in your throat and then connecting it to a ventilator

There are some shoulder surgeries, like certain rotator cuff repairs, that may require a general anesthetic in order to position the patient correctly. These surgeries typically involve the patient lying on their side, and this is a very difficult position to be comfortable in during the entire procedure. When the shoulder surgery is usually expected to last more than an hour or so, most surgeons generally prefer that the patient have a general anesthetic so that they do not start to "squirm" around during the operation.

However, the main advantage of a regional anesthetic is that you do not have to go to sleep, and many patients find that the medications that are used for general anesthesia can make them nauseated and sick to their stomach. The pain relief from a regional anesthetic can also be designed to last for up to 24 hours, and this does facilitate pain control during the first day after shoulder surgery and during outpatient surgery."
================================
http://www.nmh.org/nmh/surgicalinstructions/anesthesiaforshouldersurgery.htm
Anesthesia for Shoulder Surgery
"Your doctor has recommended a regional anesthesia for your shoulder surgery."

[starion]

Start with having your asthma doctor re-evaluate your asthma treatment plan.  Taking albuterol several times a day is a sign that your asthma is not well controlled.  Sometimes medications need to be adjusted to get better control, and sometimes we need to be evaluated for additional conditions like allergies, gastric reflux, and other conditions which may be worsening our lung function.  When your asthma is stable and under good control, it's time for the next step--scheduling your surgery.  Most surgeons will NOT schedule surgery that is not an emergency when the patient's asthma is not under good control.

Please have the surgeon who will operate on your shoulder confer with the doctor who is treating your asthma AND whomever will be administering your anesthesia about your asthma and ways to have the surgery not affect your airways.  They can discuss the various types of available anesthesia that could be used for your shoulder surgery, to come up with the methods which are safest for your lungs while still providing the required sedation.

Good luck--remember the first step is to get your asthma under good control.  You can ask your doctor if it might be beneficial for him/her to consult with National Jewish or other medical center about your case, so you do not need your rescue inhaler more than once/week.  More info about National Jewish is available at www.NationalJewish.org.

Starion