anesthesia

waters3 · 07-01-2003, 02:07 PM

Hi all,

I remember reading somewhere about general anesthesa(sp?) but I do not remember where. Tomorrow Anthony is scheduled to undergo ID (debreeding(sp)) of his pressure sores. He has one on each buttock and one big one on the tailbone. they want to take him downstairs and put him under by putting anesthesa through is trach tube. Did I hear somewhere not to do this? Please respond if anyone has written about this before. He has been on CPAP for about 2 weeks now for 10 to 12 hours a day but has not handled it well for the past 2 days. And I am worried and can stop it if I have to.

Cindy Waters (mom)
son c4,5,6
tampa, fl
injury 3/28/03

SCI-Nurse · 07-01-2003, 02:16 PM

This is done commonly, but he needs to be monitored for autonomic dysreflexia during and following this procedure, and there is a good chance that he will come out of surgery on a regular ventilator (not just C-Pap) and may remain there for some time. Be sure that the nurses and physicians are well educated about autonomic dysreflexia and how to manage it if it should occur. He will need extra quad coughing and suctioning after anesthesia as well to prevent pneumonia.

(KLD)

waters3 · 07-01-2003, 09:25 PM

This helped alot. I have all my questions in hand for tomorrow morning. I am going to also ask why they can't use a topical numbing instead. We don't need any setbacks at all. Anthony is still in the hospital and the wound drs. come in mon, tues, fri to clean and change the dressings and one has the V.A.C. on it that has worked pretty good. Is Osteomyelitis the same as flapping. Anthony is now on a "clinitron air fluidized support system". Looks and feels like a waterbed but is actually air and sand. They say you don't have to turn a person using this bed. Has anyone out there heard of that? You know I was thinking can pressure sores alone cause AD? It was explained in a document about it that AD is caused by an irritant below the level of injury that would normally hurt or harm a person without paralysis and to remove the offending stimulus. Even when he is sitting up out of nowhere he will start to sweat on his forehead sometimes just on one side sometimes just in a little area and also the red splotches mostly on the left side of his face and neck area and then they will just go away. About the time that the pressure sores were getting pretty bad is when Anthony had to go on the vent about 3 weeks after being admitted to the hospital. I wonder if this could be related?

Cindy, tampa fl
mom to Anthony C4,5,6
inury 3/28/03
still in hospital

SCI-Nurse · 07-02-2003, 09:34 AM

Even on a Clinitron he should not be sitting up with pressure ulcers. Turning should still be done on the clinitron to help his lungs.

AD can indeed be caused by pressure ulcers, and by pressure ulcer debridement. If the sores are deep enough to debride, they are too deep to debride without anesthesia. This could cause AD. Spinal could be used, but not just topical. Even just changing a dressing on a pressure ulcer can cause AD.

When he has these AD symptoms the nurses need to take his blood pressure and intervene as indicated. It should not be taken lightly.

Osteomyelitis is an infection in the bone, which is especially difficult to eliminate. It usually requires 6 weeks of IV antibiotics, and this must be treated before a myocutaneous flap (the surgery needed to properly cover and close severe pressure ulcers).

Lack of proper nutrition, especially protein input, could cause both respiratory muscle weakness and make him more subject to pressure ulcers, otherwise this is not connected. People with pressure ulcers and those who have new injuries require approximately 2X the RDA for protein intake and also about 2X their usual calorie intake.

(KLD)

waters3 · 07-03-2003, 09:09 PM

I spoke with the plastic surgeon who did Anthony's debridement right before the procedure and he was very helpful and knowledgable about AD. Anthony did fine. He was on CPAP for the rest of the day and did fine! He now has V.A.C. on all sores now just praying for good recovery to continue. To move on to rehab as soon as he can but so he can benefit fully from it. They are now doing a urine test for 24 hours to see why his protein is low.

07-01-2003, 02:07 PM	#1
waters3 Senior Member Join Date: Jun 2003 Posts: 347	anesthesia Hi all, I remember reading somewhere about general anesthesa(sp?) but I do not remember where. Tomorrow Anthony is scheduled to undergo ID (debreeding(sp)) of his pressure sores. He has one on each buttock and one big one on the tailbone. they want to take him downstairs and put him under by putting anesthesa through is trach tube. Did I hear somewhere not to do this? Please respond if anyone has written about this before. He has been on CPAP for about 2 weeks now for 10 to 12 hours a day but has not handled it well for the past 2 days. And I am worried and can stop it if I have to. Cindy Waters (mom) son c4,5,6 tampa, fl injury 3/28/03

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07-01-2003, 02:16 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,356	This is done commonly, but he needs to be monitored for autonomic dysreflexia during and following this procedure, and there is a good chance that he will come out of surgery on a regular ventilator (not just C-Pap) and may remain there for some time. Be sure that the nurses and physicians are well educated about autonomic dysreflexia and how to manage it if it should occur. He will need extra quad coughing and suctioning after anesthesia as well to prevent pneumonia. (KLD)

07-01-2003, 09:25 PM	#3
waters3 Senior Member Join Date: Jun 2003 Posts: 347	This helped alot. I have all my questions in hand for tomorrow morning. I am going to also ask why they can't use a topical numbing instead. We don't need any setbacks at all. Anthony is still in the hospital and the wound drs. come in mon, tues, fri to clean and change the dressings and one has the V.A.C. on it that has worked pretty good. Is Osteomyelitis the same as flapping. Anthony is now on a "clinitron air fluidized support system". Looks and feels like a waterbed but is actually air and sand. They say you don't have to turn a person using this bed. Has anyone out there heard of that? You know I was thinking can pressure sores alone cause AD? It was explained in a document about it that AD is caused by an irritant below the level of injury that would normally hurt or harm a person without paralysis and to remove the offending stimulus. Even when he is sitting up out of nowhere he will start to sweat on his forehead sometimes just on one side sometimes just in a little area and also the red splotches mostly on the left side of his face and neck area and then they will just go away. About the time that the pressure sores were getting pretty bad is when Anthony had to go on the vent about 3 weeks after being admitted to the hospital. I wonder if this could be related? Cindy, tampa fl mom to Anthony C4,5,6 inury 3/28/03 still in hospital

07-02-2003, 09:34 AM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,356	Even on a Clinitron he should not be sitting up with pressure ulcers. Turning should still be done on the clinitron to help his lungs. AD can indeed be caused by pressure ulcers, and by pressure ulcer debridement. If the sores are deep enough to debride, they are too deep to debride without anesthesia. This could cause AD. Spinal could be used, but not just topical. Even just changing a dressing on a pressure ulcer can cause AD. When he has these AD symptoms the nurses need to take his blood pressure and intervene as indicated. It should not be taken lightly. Osteomyelitis is an infection in the bone, which is especially difficult to eliminate. It usually requires 6 weeks of IV antibiotics, and this must be treated before a myocutaneous flap (the surgery needed to properly cover and close severe pressure ulcers). Lack of proper nutrition, especially protein input, could cause both respiratory muscle weakness and make him more subject to pressure ulcers, otherwise this is not connected. People with pressure ulcers and those who have new injuries require approximately 2X the RDA for protein intake and also about 2X their usual calorie intake. (KLD)

07-03-2003, 09:09 PM	#5
waters3 Senior Member Join Date: Jun 2003 Posts: 347	I spoke with the plastic surgeon who did Anthony's debridement right before the procedure and he was very helpful and knowledgable about AD. Anthony did fine. He was on CPAP for the rest of the day and did fine! He now has V.A.C. on all sores now just praying for good recovery to continue. To move on to rehab as soon as he can but so he can benefit fully from it. They are now doing a urine test for 24 hours to see why his protein is low.