Anesthesia Risks: Insights on OSA Surgery and Recovery

Q: Anesthesia Risks: Insights on OSA Surgery and Recovery

Hello, I would like to respond to your questions as follows： <br>1. <br>The awakening from anesthesia is related to the type of anesthesia you experienced, the surgery performed, and your individual physiological state at that moment; none of these factors are "completely" the sa

Potential harm from anesthesia, persistence?

Hello Doctor,
1.
I have undergone general anesthesia multiple times for OSA surgeries, and my experiences have varied.
On two occasions, I heard people calling my name postoperatively, but I found it difficult to wake up and felt a bit of struggle and fear.
However, on other occasions, I woke up naturally without any difficulty.
Is there a difference in these experiences?
2.
Recently, a physician from a different specialty (not a surgeon) told me that the metabolism of general anesthesia drugs takes about a week, so my sleep might improve a week after the surgery, which may not necessarily be due to the effects of the surgery itself.
However, I understand that anesthesia and sedatives are not just for inducing sleep; they do not aid in deep sleep.
Personally, I do not experience insomnia but have many dreams and sleep soundly until morning.
Can anesthesia improve sleep? Does it really take a week to metabolize?
3.
Given that I have undergone general anesthesia multiple times and am currently fine, I often hear that general anesthesia is harmful.
Does general anesthesia accumulate potential harm over time?
4.
Regarding DISE for OSA, some doctors say that under anesthesia, the muscles relax, making the results inaccurate and that it cannot be compared to natural sleep.
From an anesthetic perspective, is this true?

JWoker, 40~49 year old female. Ask Date: 2018/05/18

Dr. Lin Xiuying reply Anesthesiology

Hello, I would like to respond to your questions as follows:
1.
The awakening from anesthesia is related to the type of anesthesia you experienced, the surgery performed, and your individual physiological state at that moment; none of these factors are "completely" the same! Each healthcare professional involved in your postoperative recovery may have slightly different approaches to addressing issues, and it can be challenging to determine the exact cause without being present.
Of course, residual effects of the medication are also possible, but it is advisable to communicate your different experiences during the pre-anesthesia consultation before your next surgery.
Please ask the anesthesia team to review your medical history to identify any potential causes.
2.
From a normal pharmacological metabolism perspective, the metabolism time of anesthetic agents is typically not prolonged! Therefore, we advise patients not to engage in precision tasks on the day of surgery and anesthesia to avoid injury! Unless the patient has significant liver or kidney issues that could affect drug metabolism.
Regarding the relationship between anesthesia and sleep, certain mechanisms of anesthetic drugs do have sedative effects.
Whether deep sleep is achieved depends on the dosage and individual response.
If we were to compare anesthesia during surgery to sleep, the brain waves during deep anesthesia (stage three and four) are similar, or even lower, than those of normal sleep.
3.
Anesthesia literature does not indicate that multiple anesthetic exposures result in "potential harm"! The physiological effects on individuals are influenced by numerous factors, making it difficult to establish correlations.
4.
It is true that sleep induced by anesthetic agents differs from normal sleep states; muscle relaxation occurs regardless of whether muscle relaxants are used.
This concludes my response.

Reply Date: 2018/05/18

More Info

Understanding the risks associated with anesthesia, particularly in the context of surgeries for obstructive sleep apnea (OSA), is crucial for patients undergoing such procedures. Your questions touch on several important aspects of anesthesia and its effects on recovery, especially in relation to OSA surgery. Let’s address each of your concerns in detail.

1. Variability in Anesthesia Recovery: The differences you experienced during recovery from anesthesia can be attributed to several factors. Each surgical procedure, the type of anesthesia used, and your individual physiological responses can vary significantly. Factors such as the specific anesthetic agents administered, the duration of surgery, your overall health, and even your psychological state can influence how you wake up from anesthesia. The sensation of struggling to wake up or feeling disoriented can be related to the residual effects of the anesthetic drugs, which can vary from one procedure to another. It’s essential to communicate these experiences with your anesthesiologist prior to future surgeries, as they can tailor the anesthetic plan to minimize discomfort and improve your recovery experience.

2. Anesthesia and Sleep Quality: The assertion that anesthetic drugs take a week to metabolize and that this could affect sleep quality is somewhat misleading. While it is true that some anesthetic agents can linger in the body, most are metabolized relatively quickly, often within hours to a couple of days. However, the quality of sleep induced by anesthesia is not equivalent to natural sleep. Anesthesia can suppress certain sleep stages, particularly REM sleep, which is crucial for restorative sleep. If you are experiencing vivid dreams, it may indicate that you are entering REM sleep, but this does not necessarily mean that the sleep is restorative. If you feel that your sleep quality has improved post-surgery, it could be due to the alleviation of OSA symptoms rather than the residual effects of anesthesia.

3. Cumulative Effects of General Anesthesia: Concerns about the cumulative effects of multiple exposures to general anesthesia are valid, but current research indicates that for most patients, there is no significant long-term harm from multiple anesthetic exposures. However, certain populations, such as the elderly or those with pre-existing health conditions, may be at higher risk for complications. It’s essential to discuss your medical history and any concerns with your healthcare provider to ensure that your anesthesia plan is safe and appropriate for your situation.

4. DISE and Muscle Relaxation: Drug-Induced Sleep Endoscopy (DISE) is a valuable tool for assessing airway obstruction in patients with OSA. It is true that the muscle relaxation induced by anesthesia can alter the dynamics of airway collapse compared to natural sleep. This means that while DISE can provide insights into the anatomy and potential sites of obstruction, the findings may not fully replicate the patient’s natural sleep patterns. Therefore, while DISE is useful, it should be interpreted with caution, and the results should be integrated with other clinical evaluations to guide treatment decisions.

In conclusion, your experiences with anesthesia and OSA surgery highlight the complexity of individual responses to anesthesia and the importance of personalized care. It’s crucial to maintain open communication with your healthcare team, including anesthesiologists and sleep specialists, to address your concerns and optimize your treatment plan. If you continue to experience symptoms or have concerns about your recovery, consider seeking a second opinion or further evaluation from a sleep medicine specialist who can provide tailored recommendations based on your unique situation.

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