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Which type of Anesthesia is recommended during endoscopic sinus surgery?

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Posted on Thu, 19 Mar 2015
Question: Being a sever obs sleep apnea patient, non compliance of CPAP, trying to use Dental appliance-not able to use due severe obstruction in nasal- severe sinus infections.
1.which type Anesthesia is recommended while doing endoscopic sinus surgery and septoplasty?
2.Does Anesthesia is safe--
3.what do you suggest that with surgery as mentioned at sr number 1 will help for obs sleep apnea?.
4.Does non compliance of dental appliance is due to severe obstruction of sinus blockage?
4.Does hypothyroid condition for which synthroid is being taken ,lung noduke and diabetic will make any effects during surgery ?and afterwards


doctor
Answered by Dr. Dariush Saghafi (1 hour later)
Brief Answer:
Sinus/nasal procedures

Detailed Answer:
Good morning. I've reviewed your questions and other responses given by other physicians with whom you've consulted. I'm not a surgeon to let you know but as a neurologist I treat many people who have sleep disorders and OSA and am familiar with the many procedures that are done on them to relieve their problems. I've seen many successes due to surgical intervention and similarly many failures. What I suggest is that you check the background and credentials very carefully of whomever you choose for ANY procedure and ask them to EXPLAIN the rationale for each procedure they want to do in terms of how it is specifically going to help your OSA....at your age, with your other conditions, and large BMI, you don't want to get involved with doing things that are just not necessary or risky with little chance of a good outcome.

Specifically addressing each of your questions are the following responses:

1. For the procedures you've mentioned I believe you will have to have both general anesthesia as well as local which can be done. However, I agree with Dr. Bhatti's concern about septuplasty. At your age and with your other conditions...I believe you are placing yourself in the way of many potential complications with the likely percentage of contributing to successful outcome being very small. I would consider avoiding that procedure.

2. The phase of anesthesia is the most common place where surgical patients suffer from complications. And it's usually in the awakening phase where things tend to go wrong...not so much going under although that can be challenging as well. So is it safe? It is as safe as possible given the fact you are putting someone out and then, trying to successfully bring them out without complications....but they do occur and even in the best of hands the overall rate of problems both during and after surgery is probably around 5% nowadays. Prior to 2010 the rate was about 11%...so there has been a significant drop but there's the number you should keep in mind....5% risk of some form of complication from mild to major.

3. I am not understanding Question #3 very well. I think Dr. Bhatti gave you a comprehensive list of surgical possibilities that one could consider for OSA related to your case given some of the other complications you've had....but if you'd like to rephrase that question so I can better read it then, I'd be happy to answer it more directly.

4. I believe that having severe OSA certainly is a good reason why you are having a difficult time with your dental appliance. Have you checked back with your dentist or ENT specialist to let them know you're having problems? There may be alternative devices that could be easier for you to tolerate or that might be functionally better for you though they may not be as well fitted as what you have.

5. Your other conditions including hypothyroidism, diabetes, and a lung nodule are all things that a surgeon and anesthesiologist take into consideration while planning a procedure. I wouldn't anticipate any complications though from any of those entities as far as your procedure is concerned so long as everyone is aware of your conditions, your medications which you need to take following surgery or before to control those conditions and so forth. You may wish to have family informed as to when you need to take certain medications so that once you are in recovery and during the post-op recovery time someone can be checking up just to make sure that nursing got a full list of medications you need to be taking for all of your problems.

I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.

Don't forget that my webpage to keep me abreast as to how you're doing is:

bit.ly/drdariushsaghafi

All the Best

This query has required a total of 36 minutes of physician specific time to read, research, and compile the return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (25 hours later)
Thanks Dr.Saghafi,
you can mention those alternate available options for OBS-There may be alternative devices that could be easier for you to tolerate or that might be functionally better for you though they may not be as well fitted as what you have.
Doctor I was trying to use CPAP for last 4 years and Dental appliance- for 2 month, not able to use- narrowness in airway breath is at level 4, now severe sinus infections creating more problems,
does long term use of Carthromycin 500 mg(Bioxin) can give concerns to throat- like swelling and soarness,.
question number 3- is like that does my obstructive sleep apnea will improve with endoscopic sinus surgery?
what do you suggest for MRI brain-- attached- mentioning white matter changes and pituitary, previously they mentioned LEUKIARIOSIS IN MRI of brain
what do you suggest for reason of center of headache- and back of head right ,left and center with specific below ear right side.
eyes are swelling up, using eye drops, may be infection of sinus. enclosing some of allergy tests -
dont know here why doctors are not considering these test results for evaluation before surgery--
doctor
Answered by Dr. Dariush Saghafi (24 hours later)
Brief Answer:
Thank you for your return note

Detailed Answer:
#1- Mention those alternate available options for OBS etc.

Unfortunately, my comment of the possibility of alternate dental devices for your increased comfort was only meant to provide you with a question that you could ask your dentist or other doctors about. I am not well versed in all the different equipment that dentists have at their disposal that could be used. However, your complaint of the device making it difficult to breathe simply led me to suggest that you talk things over with your doctors. Often times they may not be aware of what's going on and if for only knowing there were a problem would gladly change you for something else...but the fact is, many patients simply don't say anything and go on either suffering or they stop using their equipment.

As far as types of APNEA machines I can tell you that some of my patients tolerate the masks of bi-pap much better and are more comfortable with those compared to cpap machines. Don't know if that may make a difference to you or not.

#2- I would be more concerned of the long term use of any ANTIBIOTIC in causing resistance to the drug or causing other complications such as bacterial overgrowth and secondary infections both in the sinuses as well as urinary and GI Tracts. I do not know of significant cases of "throat swelling and soreness" as a direct consequence of that or any antibiotic use unless it were having a direct toxic effect to the lining of the pharynx or esophagus which doesn't really happen. So the answer to your question in this case, in my opinion, is NO...complaints are unrelated to the medication.

#3- The likelihood or not of your sleep apnea improving based upon an endoscopic sinus procedure is entirely based upon the appropriateness of the procedure to the problem at hand and the type of patient being selected as well as how likely it is that sinus obstructions are the root cause of your OSA. You should know that many patients with OSA (at least with diagnosed OSA by sleep study parameters) obtain no significant relief after surgical intervention. Others do. I think a XXXXXXX discussion with your surgeon regarding exactly the questions I've posed will get you the answer you seek. I'm afraid I'm in a disadvantaged position to give you the best answer compared to your own physicians.

If they cannot give you a satisfactory response by posing the above questions then, I recommend you obtain a 2nd opinion on the value of a surgical procedure to correct your sleep apnea. Remember, you also have other risk factors as I recall from reading other information about your condition (i.e. HIGH BMI, other medical conditions such as hypothyroidism, etc.).

#4- I read the MRI report that you've attached several times. I find it to be quite UNREMARKABLE with respect to the discussion of the cerebral hemispheres, the pituitary gland, and I did not see the term LEUKOARIOSIS even mentioned in the report at all. I tried opening your other files of the CT scans to see if perhaps it was in there but was unsuccessful. The links do not work.

My guess is that probably have a normal neurological examination all the way around. The term LEUKOARIOSIS is synonymous with NONSPECIFIC white matter changes which can be seen in all individuals no matter state of health or anything and can be seen just as a normal process of aging. In people who are smokers, diabetics, hypertensives, renal disease patients, high cholesterol patients, etc. etc. the finding of leukoariosis can be more prominent....but it still doesn't mean anything to us CLINICALLY as neurologists unless there are neurological abnormalities or FOCALITIES that we can point to which could then, be explained by way of these white matter intensities.

Bottom line- I did not see it mentioned in the attached MRI report....but in any event I don't believe it has any relevance to your case at hand and you should not worry about that situation.

#5- localization of the headache as you describe cannot be linked to anything specific in my opinion UNLESS it is any the specific area where the sinus cavities are either believed to be abnormal...in which case MAYBE but I repeat MAYBE there could be some correlation. Generally, the location of a headache tells us very little as to what the cause of the heaache is and there are individuals who in fact, suffer injuries such as STROKES over one part of the brain but have headaches that are either all over the head or in some other location. Again, location of headache and clinically relevance does not always correlate nicely for us so I don't think this is helpful to worry too much about at this point.

#6- as one not expert in allergy medicine or what the exact context in which the allergy test results were obtained I would prefer to not mislead you with any erroneous information. I would suggest you ask your doctors DIRECTLY the question you asked....perhaps you will discover that in fact THEY HAVE seen these results, considered them prior to surgery, but they simply have not communicated their thought process to you...or the results of those tests are not relevant to what they are intending on doing...again, only they would know why that should be the case.

Once again, I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful as this allows for our transaction to be processed, archived, and available to others for use as necessay.

Don't forget that my webpage to keep me abreast as to how you're doing is:

bit.ly/drdariushsaghafi

All the Best

This query has required a total of 66 minutes of physician specific time to read, research, and compile the return envoy to the patient.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2473 Questions

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Which type of Anesthesia is recommended during endoscopic sinus surgery?

Brief Answer: Sinus/nasal procedures Detailed Answer: Good morning. I've reviewed your questions and other responses given by other physicians with whom you've consulted. I'm not a surgeon to let you know but as a neurologist I treat many people who have sleep disorders and OSA and am familiar with the many procedures that are done on them to relieve their problems. I've seen many successes due to surgical intervention and similarly many failures. What I suggest is that you check the background and credentials very carefully of whomever you choose for ANY procedure and ask them to EXPLAIN the rationale for each procedure they want to do in terms of how it is specifically going to help your OSA....at your age, with your other conditions, and large BMI, you don't want to get involved with doing things that are just not necessary or risky with little chance of a good outcome. Specifically addressing each of your questions are the following responses: 1. For the procedures you've mentioned I believe you will have to have both general anesthesia as well as local which can be done. However, I agree with Dr. Bhatti's concern about septuplasty. At your age and with your other conditions...I believe you are placing yourself in the way of many potential complications with the likely percentage of contributing to successful outcome being very small. I would consider avoiding that procedure. 2. The phase of anesthesia is the most common place where surgical patients suffer from complications. And it's usually in the awakening phase where things tend to go wrong...not so much going under although that can be challenging as well. So is it safe? It is as safe as possible given the fact you are putting someone out and then, trying to successfully bring them out without complications....but they do occur and even in the best of hands the overall rate of problems both during and after surgery is probably around 5% nowadays. Prior to 2010 the rate was about 11%...so there has been a significant drop but there's the number you should keep in mind....5% risk of some form of complication from mild to major. 3. I am not understanding Question #3 very well. I think Dr. Bhatti gave you a comprehensive list of surgical possibilities that one could consider for OSA related to your case given some of the other complications you've had....but if you'd like to rephrase that question so I can better read it then, I'd be happy to answer it more directly. 4. I believe that having severe OSA certainly is a good reason why you are having a difficult time with your dental appliance. Have you checked back with your dentist or ENT specialist to let them know you're having problems? There may be alternative devices that could be easier for you to tolerate or that might be functionally better for you though they may not be as well fitted as what you have. 5. Your other conditions including hypothyroidism, diabetes, and a lung nodule are all things that a surgeon and anesthesiologist take into consideration while planning a procedure. I wouldn't anticipate any complications though from any of those entities as far as your procedure is concerned so long as everyone is aware of your conditions, your medications which you need to take following surgery or before to control those conditions and so forth. You may wish to have family informed as to when you need to take certain medications so that once you are in recovery and during the post-op recovery time someone can be checking up just to make sure that nursing got a full list of medications you need to be taking for all of your problems. I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful. Don't forget that my webpage to keep me abreast as to how you're doing is: bit.ly/drdariushsaghafi All the Best This query has required a total of 36 minutes of physician specific time to read, research, and compile the return envoy to the patient.