anesthesia

i'd like to ask all those out there, especially with stents and congestive heart failure, what is the big risk with anesthesia?

i've been rejected twice in the last month for needed procedures outside of the heart realm. one case , i didn't stop my blood thinners soon enough (plavix, aspirin), the other is i stopped them too soon. each doctor seems to have their own opinion on the matter.
i finally got in touch with the director of anesthesia at the hospital and he informed me that now people with my condition should not stop any thinners at all. all of this is new to me. every other operation i have had in the past i was told to stop both for a while or at least one prior to surgery to cut down on unnecessary bleeding. his only explanation was that the anesthesia tends to clot the blood , has anyone else heard of this?

needless to say my opinion of doctors' opinions is a bit apprehensive. and i don't know who to trust or believe anymore. anyone with information or knowledge on this subject, please respond.
many thanks.

5 Comments

Blood lots

by SMITTY - 2008-08-11 10:08:38

Hi Verger,

Evidently that train runs both directions. I've had discussions about this when I was having surgery and it has been explained as follows:

A patient having surgery while under a general anesthetic may lose enough blood to prevent sufficient blood clotting which would stop excessive blood loss. On the other had that same patient may be immobile for an extended time and can have blood clots to form due to blood pooling in some low blood flow areas of the body.

I have a total of six stents and have congestive heart failure. When I have gotten the stents the only concern for me has been that I take an anticlotting medication afterward. I had bypass surgery 25+ years ago and I was given coumadin for a couple of days before the surgery. I now know that was because the surgery would be several hours long and then I would be immobile for a couple of days afterward and blood clots forming during my long period of inactivity was a concern. It turns out that the coumadin almost did me in and I ended up getting some 9 or 10 pints of blood while in recovery due to excessive bleeding caused by the coumadin. Also I don't recall enough details after all these years, but there was some concern about clots forming while I was on the bypass pump.

It apparently is an extremely delicate balance that causes the doctor to have to be very careful.

Smitty

Surgery with CHF and Stents

by maryanne - 2008-08-11 11:08:19

Here's the skinny. If you are on Plavix or any other anitcoagulation medications any sugeon will look at you with caution. Especially the Plavix. You say you have a stent. Well you need the Plavix for your stent to help prevent a certain mechanisim of the clotting cascade to kick in. In other words you need to be on Plavix. Plavix has a long half life. So even if you were to have surgery they would have to take you off of your Plavix for a certain period of time.

Now CHF, I don't know how much you know about CHF(Congestive Heart Failure) In simple terms it means your heart does not work effectively as a pump.

So here you have a heart that is not working effectively as a pump and someone who is also on blood thinner......that is not a good combination for surgery. So you sugreon would be correct on erring on the side of caution....and consider yourself lucky that they have taken that road.

Now that is not to say you can't eventually have surgery, but you would be considered a high risk. Now in Canada your surgery would be done high risk or not if it is dertermined you need the surgery. You see, we don't have HMO's that dictate whether you can have the surgery or not. Now you would also be considered high risk here....the difference is you wouldn't be denied care or treatment.

So long and short....you have to very complicated medical issues...it truly is up to the surgeon to approve you surgey and then the HMO to approve .....you will most probably require more post operative care than someone who didn't have a stent or CHF and hence your HMO is not eager to promote or encourate this procedure.

Not sure if this helped at all....but if you have any further questions I would be happy to provide you with as much information as possible.

Cheers...and good health to you....

surgery

by thomast - 2008-08-11 11:08:46

I have CHF that is why I have bi-ven in sync unit. I have had two surgerys in the last two years where I was put to sleep. In both cases I was told to stop blood thinner and ibuprofen for 5 days prior to surgery. The Med tromic tech checked me over prior to the surgery. Both of mine were relative short procedures, the one in 07 was to replace a joint in my left thumb, and the one in 06 was for hemoroids. No problems with either one. I take 4 mg of coumnadin per day.

Thomas

Tough Call

by chiliman - 2008-08-11 11:08:53

You definitely need additional information, and if you have insurance that will allow for a second opinion, it would be well worth your time to invoke that provision.

Maryanne is correct, as you are at a higher risk from surgical complications, but it would seem to me that your cardiologist, not the orthopedic surgeon would be well worth consulting with this issue. He/she would likely be aware of the history and severity of your cardiac condition, and could either advise your orthopedist in consultation, or help direct you to an orthopedic surgeon who has more experience with high risk cardiac patients.

Best wishes.

Risk

by ElectricFrank - 2008-08-12 12:08:13

As everyone has aptly put it you are dealing with a risk issue. The bottom line though is that it should be you, not the doctor who makes the final decision on the risk/benefit of the surgery. The potential surgical team should be able to tell you the tell you the tradeoffs of the various options so you can decide.

One way of thinking about it is suppose you were in an auto accident and experienced serious internal injuries. Would the doc refuse to operate because of your heart condition and let you die from the injuries. In this case the benefit of the surgery clearly outweighs the risk. On the other hand if you were asking for cosmetic surgery the benefit wouldn't justify the risk. There are a whole range of possibilities between these examples.

frank

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