general anaesthesia for 80+ elderly with severe diabetes

[ETatBKK]

hi there

my mother-in-law is in hospital and scheduled for a thigh bone operation. she is 80+ and has severe diabetes and other heterogeneous diseases, that makes everyone nervous ! yesterday her blood sugar level dropped from 120+ to 25 ( sorry I am not able to describe the technical details ).

QUESTION : is there any hospital in Bangkok has good and experienced anaesthesiologist who could manage this complexity ? any recommended hospital and name of anaesthesiologist will be greatly appreciated ?

what ever we could secure for a safe operation ?

I am nervous too !

[Sheryl]

Pretty much all the major hospitals have competent anesthesiologists on staff (and some less good ones) but there is really no way you can hand pick them. What I rely on is the selection of surgeon: surgeons know exactly who the best and worst "gas men" are and a top surgeon will not risk his reputation and track record operating with a subpar anesthesiologist.

So my best advice is to hand pick the surgeon. And, when you have, accompany her to the doctor and specifically mention your concerns abut anesthesia and ask if you can meet the anesthesiologist in advance.

Not to add to your worries, but it is not just the anesthesia that is of concern given her age and history. Proper management of her blood sugar will be a challenge and diabetes pre-disposes to post-op infection.

What exactly is wrong with her? Is it a hip fracture or what? And does she have insurance? Or is she Thai and covered under the universal health scheme (in which case changing hospitals is really not an option)?

[ETatBKK]

Pretty much all the major hospitals have competent anesthesiologists on staff (and some less good ones) but there is really no way you can hand pick them. What I rely on is the selection of surgeon: surgeons know exactly who the best and worst "gas men" are and a top surgeon will not risk his reputation and track record operating with a subpar anesthesiologist.

So my best advice is to hand pick the surgeon. And, when you have, accompany her to the doctor and specifically mention your concerns abut anesthesia and ask if you can meet the anesthesiologist in advance.

Not to add to your worries, but it is not just the anesthesia that is of concern given her age and history. Proper management of her blood sugar will be a challenge and diabetes pre-disposes to post-op infection.

What exactly is wrong with her? Is it a hip fracture or what? And does she have insurance? Or is she Thai and covered under the universal health scheme (in which case changing hospitals is really not an option)?

thanks Sheryl

she fell down and broke her thigh bone ( above knee ) last week, luckily not the hip joint. she has long history of severe diabetes and also the severe osteoporosis, to the point recently her bone not able to produce enough new blood.

it makes very good sense that starts with the surgeon, then the anaesthesiologist. my father-in-law and my brother-in-law didn't want to change another hospital, as her diabetes doctor is resident there. I have to respect to their decision. hope this will help too.

she is a Thai and not sure what health scheme with her. whatever possibility available, that will be under my reminding saving. I experienced those days with my parents, I will help whatever I could.

[Sheryl]

She will be under the Thai universal coverage (AKA "30 baht") system and eligible for virtually free care. Doing this privately would cost hundreds of thousands of baht.

Do you happen to know which government hospital she goes to? The larger ones are pretty good..low on amenities, but usually good quality.

Main thing is making sure the surgeon and anesthesiologist are both thoroughly aware of her unstable diabetes. Her age, they'll know right off the bat, but they'd have to read through her old records to get the rest and busy doctors don't always do this especially in Thailand. Thais can be shy about speaking up to doctors, so if you want to help, going along and speaking up might be the best way to contribute,

[ETatBKK]

Bhumibol Adulyadej Hospital, I spot on the amount of young practitioners there, that makes me worry.

my in-law family decided to stay there. I suggest to them that her diabetes specialist, the surgeon and the anaesthesiologist should meet before the process.

ok, everything will happen tomorrow. be creative and twist my figures !

thanks Sheryl, always !