Spinal block Anaesthia level of awareness.

[sapson]

Almost about to do possibly, maybe, finally have an inguinal hernia operation, but i am extremely anxious etc.

 

The private hospital surgeons normal procedure is spinal block anaesthesia and this is my concern, i informed him that my normal bp readings relaxing at home are around the 120/80 s pulse 60-75 but with a hospital operation could be absolutely off the scale....... at consultation time was 150/100 pulse 98, so the morning of operation likely to be much more concerningly high.

 

He said he could give me an injection that would mean i would be oblivious to the whole procedure....... is that actually possible without general anesthetic or is this Thai style reassurance and lets collect the fees tell him what he wants to hear and deal with the panicking guy as required, if so i need to go elsewhere with a GA,

 

Also mentioned mesh guard is that a particular brand of mesh or method? showed me a photo of his previous hernia op with a mesh in place deep in the abdomen with black stitches on four corners. Also mentioned no stiches to be removed post op guess thats now standard.

 

Another query as a diabetic my morning wake up blood sugars are around 6 to 8 and if i dont eat breakfast within an hour or so i feel odd with any blood sugar under about 6.

 

As you are fasting nothing from 12 pm night before how can you get around the drop in blood sugar on the morning of the operation with check in at 9am and pre op checks plus preparation etc and the operation time could well be late afternoon before allowed anything by mouth..........my sugar levels would be way to low by then, mentioned this to him and i  suggested electrolyte or glucose drink................but he was adamant only tiny amount of water and certainly with nothing added........is their a standard way to deal with this for diabetics who must routinely be facing surgery.

 

Also have to plan post op care, generally how long before you can hop on a small auto scooter to pop to the shops independently.

 

Thanks for any input or advice.

[sapson]

Too much information perhaps? or my incorrect spelling in the title which cant be edited now!

 

Must be a knowledgeable soul in the house somewhere.

[RichCor]

@Sheryl is the probably the one who can respond to your questions. 

[Sheryl]

Hernia repair can be done under either spinal or general anesthetic. Given your anxiety I would suggest general.

 

They can indeed give you IV sedation during spinal anesthesia but knowing usual Thai practice it will be a dose of midazalopam which will probably not knock you out...because even small amounts of sedation do knock out Thai patients and this is what they are used to.

 

The fasting is unavoidable and the stress of the event will raise your blood sugar, I would not worry about that.

 

Use of mesh is standard in hernia repairs. Good article here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025220/

 

As it sounds like you are having this done in a private hospital there is no need to proceed with a surgeon you are not fully comfortable with nor with an anesthesia plan you do not like.  Change doctors/hospital. Where in Thailand do you live?

 

[sapson]

45 minutes ago, Sheryl said:

Hernia repair can be done under either spinal or general anesthetic. Given your anxiety I would suggest general.

 

They can indeed give you IV sedation during spinal anesthesia but knowing usual Thai practice it will be a dose of midazalopam which will probably not knock you out...because even small amounts of sedation do knock out Thai patients and this is what they are used to.

 

The fasting is unavoidable and the stress of the event will raise your blood sugar, I would not worry about that.

 

Use of mesh is standard in hernia repairs. Good article here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025220/

 

As it sounds like you are having this done in a private hospital there is no need to proceed with a surgeon you are not fully comfortable with nor with an anesthesia plan you do not like.  Change doctors/hospital. Where in Thailand do you live?

 

Thanks Sheryl .. the surgeon is ok at a khon Kaen private hospital the lesser of the big three in terms of price and have told him about my fears.

 

However the most caring listening surgeon spoken to a year or so ago with a GA procedure is at the top hospital chain here with a price quote 20k more and a huge tendency to pad the bill. 

 

Sadly at this lesser private hospital the general level of English by the nurses is very very basic compared to the reasonable English at Bkk hospital with the 20k higher price tag.

 

Sinagarin or kk hospital will be the best price wise but waits and crowd scenes of course ... do the government hospitals use General Anesthesia or spinal.

 

Would hopping on a scooter locally after two weeks be realistic ..trying to plan the after care logistics.

 

Thanks

 

 

[Sheryl]

GA will cost more, it is true. There will also be an added charge for IV sedation. Might be worth discussing clealry with them what type of sedation, what you want is propofol and not just a benzo.

 

Scooter 2 weeks later no. Car travel, yes.

[sapson]

13 minutes ago, Sheryl said:

GA will cost more, it is true. There will also be an added charge for IV sedation. Might be worth discussing clealry with them what type of sedation, what you want is propofol and not just a benzo.

 

Scooter 2 weeks later no. Car travel, yes.

Thanks ..so small scooter motorbike will be more like a month before able to ride short hops.?

 

Do the government hospitals as in Sinagarind or Khon Kaen hospital normally use General Anesthesia or spinal.

 

[Sheryl]

The govt hospitals usually use spinal.

 

A private hospital ought to be able to do general on request. However if you can be sure they will really knock you out with IV sedation (i.e. propofol not just a tranquillizer) than that together wiht spinal should suffice. Probably nto possible in a govt hospital but no reason a priavte can't do it, thogu there may be an extra charge.

 

Yes should be able to ride a scooter after about 4 weeks. You can resume "light" activities after 2 weeks, mrtoe strenuous after 406.

 

 

[tifino]

I had a Dual (one either side) IngH 

Went General Aseth'

 

 

Only trouble, was actually after the OP, and back in the Ward...  

 - Lesson One - do not have Visitors who make you laugh!! 

 

 

[sapson]

2 hours ago, tifino said:

I had a Dual (one either side) IngH 

Went General Aseth'

 

 

Only trouble, was actually after the OP, and back in the Ward...  

 - Lesson One - do not have Visitors who make you laugh!! 

 

 

I will heed the warning and not let my Thai helper induce laughter although im going to need an injection of humour at the bill paying time.

[sapson]

3 hours ago, Sheryl said:

The govt hospitals usually use spinal.

 

A private hospital ought to be able to do general on request. However if you can be sure they will really knock you out with IV sedation (i.e. propofol not just a tranquillizer) than that together wiht spinal should suffice. Probably nto possible in a govt hospital but no reason a priavte can't do it, thogu there may be an extra charge.

 

Yes should be able to ride a scooter after about 4 weeks. You can resume "light" activities after 2 weeks, mrtoe strenuous after 406.

 

 

Thanks for your input Sheryl much appreciated.

[BigStar]

21 hours ago, Sheryl said:

knowing usual Thai practice it will be a dose of midazalopam which will probably not knock you out

But you'll feel just so totally comfortable, it won't matter.

 

Too much paranoia; listen to the doc and stick to the plan. You're undergoing a very well-established procedure.

[sapson]

1 hour ago, BigStar said:

But you'll feel just so totally comfortable, it won't matter.

 

Too much paranoia; listen to the doc and stick to the plan. You're undergoing a very well-established procedure.

Thanks, the operation scheduled  just ten days away I am already getting stressed and by the time of the actual day going to be pretty frazzled and the pre op checks ECG etc and BP could be off the scale.

 

However i could take a little diazepam for a couple of days before to take the edge off the build up and on the morning hope they zap me quickly into a calmer state. 

 

Any guys actually have any recent hernia op experiences here in Thailand?

 

[Sheryl]

Many TV members have has hernia repairs here, try googling " hernia site:thaivisa.com"

[Sheryl]

2 hours ago, BigStar said:

But you'll feel just so totally comfortable, it won't matter.

 

Too much paranoia; listen to the doc and stick to the plan. You're undergoing a very well-established procedure.

 

Actually at usual Thai doses, if only low dose of a benzo used,  he might not. But he can discuss ahead of time with them what sort of sedation will be used.

[BigStar]

2 hours ago, Sheryl said:

 

Actually at usual Thai doses, if only low dose of a benzo used,  he might not. But he can discuss ahead of time with them what sort of sedation will be used.

Isn't there an anesthesiologist involved? If so, he/she must be experienced in making distinctions in physique routinely, and not just between Thai and farang. Even a Pattaya baht bus driver knows this and may, if in a cheating mood, try to add an extra "weight" charge.

[Sheryl]

23 minutes ago, BigStar said:

Isn't there an anesthesiologist involved? If so, he/she must be experienced in making distinctions in physique routinely, and not just between Thai and farang. Even a Pattaya baht bus driver knows this and may, if in a cheating mood, try to add an extra "weight" charge.

 

 

In my experience Thai anesthesiologists base their dosing on Thai norms, and do not seem to understand the higher sedation threshold of Westerners (which is not just a matter of size or weight -- Thais are extraordinarily susceptible to sedation). I have had this experience repeatedly here and seen it with innumerable others. It is an issue for both pain medication and for sedation.

[sapson]

Now just a few days away i was wondering what pre op checks on the morning would be the norm at a private hospital and from those tests what would cause the delay or postponement of the operation ?

[Sheryl]

Pre-op blood work is normally done at least 1 day before not the morning of the op.

 

Anesthetist will come to see you the morning of the surgery, confirm your medical history and do a very quick heart lung check.

 

It is extremely unlikely the surgery will need to be postponed on medical grounds.

[sapson]

11 minutes ago, Sheryl said:

Pre-op blood work is normally done at least 1 day before not the morning of the op.

 

Anesthetist will come to see you the morning of the surgery, confirm your medical history and do a very quick heart lung check.

 

It is extremely unlikely the surgery will need to be postponed on medical grounds.

interesting I thought they should do pre ops a day before as well but the instructions I have are dont eat or drink after midnight..............come in at 9am and pre ops checks will be done and then surgery that day,

 

Thats why was concerned blood sugars would be so low if they dont actually get around to the surgery until mid afternoon etc.

 

Sadly the American lady who worked their and spoke perfect Thai is no longer with them so any queries are going through the language barriers.

[thaibeachlovers]

On 8/10/2020 at 1:37 AM, sapson said:

The private hospital surgeons normal procedure is spinal block anaesthesia and this is my concern, i informed him that my normal bp readings relaxing at home are around the 120/80 s pulse 60-75 but with a hospital operation could be absolutely off the scale....... at consultation time was 150/100 pulse 98, so the morning of operation likely to be much more concerningly high.

 

He said he could give me an injection that would mean i would be oblivious to the whole procedure....... is that actually possible without general anesthetic or is this Thai style reassurance and lets collect the fees tell him what he wants to hear and deal with the panicking guy as required, if so i need to go elsewhere with a GA,

I had an op done under sedation with local anaesthetic, and if done properly you have nothing to worry about.

Is he going to have an anesthetist give the sedation? If not then ask ( pay ) for one or go elsewhere, IMO.

GA Is far more dangerous than deep

sedation, but both need, IMO, an anesthetist.

 

On 8/10/2020 at 1:37 AM, sapson said:

Also mentioned no stiches to be removed post op guess thats now standard.

Dissolving suture are nothing new.

 

On 8/10/2020 at 1:37 AM, sapson said:

Another query as a diabetic my morning wake up blood sugars are around 6 to 8 and if i dont eat breakfast within an hour or so i feel odd with any blood sugar under about 6.

You are not the first diabetic to be operated on. As long as they know, you should be OK. You have to fast for GA too. That is something to discuss with the anesthetist.

 

On 8/10/2020 at 1:37 AM, sapson said:

Also have to plan post op care, generally how long before you can hop on a small auto scooter to pop to the shops independently.

That's a question for the surgeon, but you might want to hire a maid to do errands for a while.

[Sheryl]

18 minutes ago, sapson said:

interesting I thought they should do pre ops a day before as well but the instructions I have are dont eat or drink after midnight..............come in at 9am and pre ops checks will be done and then surgery that day,

 

Thats why was concerned blood sugars would be so low if they dont actually get around to the surgery until mid afternoon etc.

 

Sadly the American lady who worked their and spoke perfect Thai is no longer with them so any queries are going through the language barriers.

As previously explained the stress of the op will tend to raise blood sugar.

 

If your sugar is low, or the surgery long delayed, they will administer an IV with glucose.

 

Try not to over-think and worry too much. It doesn't help. This is a very common operation.

[sapson]

1 hour ago, thaibeachlovers said:

That's a question for the surgeon, but you might want to hire a maid to do errands for a while.

Thanks for your input much appreciated, yes a Thai girl friend will be with me for a week post op to run errands etc.

 

Just so used to my motorbike for freedom of mobility its always got me home sometimes on autopilot.

[phetphet]

On 8/10/2020 at 8:11 PM, sapson said:

I will heed the warning and not let my Thai helper induce laughter although im going to need an injection of humour at the bill paying time.

Another thing to be aware of. Anaesthetics can cause constipation. Believe me, you do not want that after having stitches. Drink plenty of fluids after the op, and if they send you home, make sure you have some strong laxative available. Just in case.

[sapson]

1 hour ago, Sheryl said:

Try not to over-think and worry too much. It doesn't help. This is a very common operation.

Yes as surgery goes very routine...... had the other side done 25 years ago in the Uk. 

 

I must indeed try not to stress!! working on that concept.

[sapson]

50 minutes ago, phetphet said:

Another thing to be aware of. Anaesthetics can cause constipation. Believe me, you do not want that after having stitches. Drink plenty of fluids after the op, and if they send you home, make sure you have some strong laxative available. Just in case.

Thought about that, not sure if it applies so much with spinal block anaesthetic? or more so with General anaesthetic or a side effect of pain killers, but will get some stool softener and laxative.

 

Part of the package is 2 nights stay so hoping they check all the plumbing works in that time before I exit, when i get the final bill that for sure will loosen things up.

Edited August 17, 2020 by sapson