A (LONG) thread for patients with #mecfs #longcovid expecting surgery and the #surgeons #anesthesiologists #crnas and #pacunurses caring for them. I'll share my recent perioperative experience. This is neither comprehensive nor medical advice, but I hope it helps. (0)
1. Recovery was a bitch. I've had general anesthetics before, even in the same organ system. This was not the same body undergoing #anesthesia.
2. Set Expectations: Physicians
Expect long lists of meds, allergies, requests, and questions. Listen to and engage with your patient. They may educate you. Anticipate a potentially prolonged and complicated recovery. This is not a fast-track. Respectfully, don't be a Dick.
Expect long lists of meds, allergies, requests, and questions. Listen to and engage with your patient. They may educate you. Anticipate a potentially prolonged and complicated recovery. This is not a fast-track. Respectfully, don't be a Dick.
3. Set expectations: Patients
This is will be hard. Know your "why". When deciding to undergo elective surgery ask questions, get 2nd/3rd opinions, then commit. Anticipate a postop flare in symptoms. Have your support systems in place. Breathe. You got this.
This is will be hard. Know your "why". When deciding to undergo elective surgery ask questions, get 2nd/3rd opinions, then commit. Anticipate a postop flare in symptoms. Have your support systems in place. Breathe. You got this.
4. Preop
Optimize patient medically. Consider cardiomyopathy, lung damage, coagulopathy, dysautonomia, central sleep apnea, neuropathies. Review meds thoroughly and have a plan to manage: low-dose naltrexone, beta bx, anticoagulants. Plan multimodal analgesia...
Optimize patient medically. Consider cardiomyopathy, lung damage, coagulopathy, dysautonomia, central sleep apnea, neuropathies. Review meds thoroughly and have a plan to manage: low-dose naltrexone, beta bx, anticoagulants. Plan multimodal analgesia...
5. Preop cont'd
Great opportunity for #PhysicianCollaboration. #longcovid patients see many docs. Call each other, ask ?s. Learn what may be relevant to #anesthesia and #surgery. Then share what you learn with your MD/(AP)RN colleagues, cuz you're gonna see it again.
Great opportunity for #PhysicianCollaboration. #longcovid patients see many docs. Call each other, ask ?s. Learn what may be relevant to #anesthesia and #surgery. Then share what you learn with your MD/(AP)RN colleagues, cuz you're gonna see it again.
6. Preop tips for Patients
The days leading to #surgery, optimize your health. Hydrate for #POTS, take your inhalers, follow pre-op med instructions. Maximize sleep. Pace like a mother. This is not the time to get everything done. Rest is key...
The days leading to #surgery, optimize your health. Hydrate for #POTS, take your inhalers, follow pre-op med instructions. Maximize sleep. Pace like a mother. This is not the time to get everything done. Rest is key...
7. Preop tips for Patients cont'd
Spend energy on planning a ride home, meals, and backup child/pet care if you are admitted. Have comfy loungewear, dry shampoo, body wipes, Colgate wisps, and a trashcan by your bed. Maybe also a scented candle?
Spend energy on planning a ride home, meals, and backup child/pet care if you are admitted. Have comfy loungewear, dry shampoo, body wipes, Colgate wisps, and a trashcan by your bed. Maybe also a scented candle?
8. Intraop
I don't know surgery, I know #anesthesiology, so I will focus there. Titrate meds to effect. #longcovid #mecfs patients are hyper sensitive to anesthetics and benzos. I would advise caution with neuro blockade, too...
I don't know surgery, I know #anesthesiology, so I will focus there. Titrate meds to effect. #longcovid #mecfs patients are hyper sensitive to anesthetics and benzos. I would advise caution with neuro blockade, too...
9. Intraop cont'd:
Avoid histaminergic meds, consider H1/H2 bx. Stay vigilant for allergic rxn. See Mast Cell Activation Syndrome #MCAS. Know that Low-Dose Naltrexone often used as anti-inflammatory. Volume is key tx for #POTS #dysautonomia. Consider foley/straight cath.
Avoid histaminergic meds, consider H1/H2 bx. Stay vigilant for allergic rxn. See Mast Cell Activation Syndrome #MCAS. Know that Low-Dose Naltrexone often used as anti-inflammatory. Volume is key tx for #POTS #dysautonomia. Consider foley/straight cath.
10. PACU: Pts can suffer sensory overload. Reduce stimuli. Cover pt's eyes, consider headphones, speak softly. Reassure. Provide anxiolysis. But remember #longcovid is not #anxiety. It's a neurovascular dz. Keep dangerous diagnoses high on differential. MI, CVA, PE, etc.
11. Discharge:
PACU stay may be prolonged AND you may be going home while uncomfortable. Patients: Have a responsible adult help manage your postop meds. Docs: write clear discharge instructions and consider calling regularly. This may prevent a readmission.
PACU stay may be prolonged AND you may be going home while uncomfortable. Patients: Have a responsible adult help manage your postop meds. Docs: write clear discharge instructions and consider calling regularly. This may prevent a readmission.
End. We will see more #longcovid #mecfs patients in the #OR, some will be our former medical colleagues. I'm biased but I think #anesthesiologists are particularly equipped to handle the complexity. Remember humility and kindness first, this disease is awful. @apsf @ASALifeline
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