dry throat and intubation tube?

[Julie]

With this upcoming gallbladder surgery, I've mentioned my anesthesia fears on here, but I am just as fearful of the intubation tube.  Everything I swallow gets stuck.  I had a swallow study a few years ago that shows that food does physically hang up, but they said nothing could be done about it.  I had an endoscopy back in the 80's and they had trouble getting it in,  and it resulted in the WORST sore throat for an entire month..and that is no exaggeration.

My throat and airway are more narrow, dry and troublesome in recent years and my mouth is very small.  I am very concerned about that tube tearing something or getting stuck in there.  My thyroid is enlarged too, so I wonder if that will pose a problem in passing that tube?

I mentioned my fear of the tube to the surgeon this week and asked if they would lube it up or what precautions would they take.  All he said was " I've had patients with Sjogrens before who didn't seem to have any problems."

For those of you with really dry throats and swallowing difficulty,  have you had surgery with the intubation tube without problems? 

Thanks for your input.

Julie

[ohiolady]

Yes, I'm scoped every year and I have had two surgeries.  At first, I was beside myself with fear because I'm very dry but it was okay.  The first time, my gastroenterologist used a pediatric scope but after that I didn't need it.  So that is an option.  It will probably work out better than you think.  At least that has been my experience.

Anna

[JannaLee]

Yes, yes!  Be sure to tell the anesthesiologist (usually he will speak to you just before the procedure) about your very dry throat and ask him to make accommodations for it.  I've heard they can use a lubricant on the tube if needed.

I guess I would also tell the nurses and anyone else who might be around when they put you under.

Good luck Julie!

[aussie mum]

I haven't got any experience to draw on but I have two suggestions:

1) See if you can have an appointment with the Anesthetist prior to the day of the surgery, rather than just 5 mins with them on the day... that way you can talk about your concerns.
2) Ask the surgeon if you could be first on the list, so you don't sit around for ages being Nil by Mouth.

Good Luck Julie, hope all goes well.

Aussie Mum

[iluvmycat]

My GI doc gave me an endoscopy and he had to widen my esophagus. He was able to do that with me.

[yankeeinthesouth]

Julie,
I had surgery last year and they used something called a DMAP on me. They said it is less invasive than the normal tubes...I guess it doesnt go in as far. I have a very dry throat and was so afraid I wouldn't be able to swallow afterwards, but they did a great job with that and lubrication. I didn't end up with even a sore throat.

I would be sure to stress to the drs that you are very dry, and you have problems swallowing. And ask about the other type of intubation.

Good Luck, my prayers will be with you.

[selavy59]

Last time I had an op was on my ears to put a grommet in. I was not diagnosed at that time, however there were complications due to intubation and they kept me in another 24 hrs observation. I won't go into detail for obvious reasons.

Please do tell the Anaesthetist. You might also want to tell them you have dry mouth problems so you do not suffer during Nil-by-Mouth and also post op.

[HL in NY]

I've also had trouble with intubation. The last time I had it for sugery, I was vomiting blood (not good). When I had my ankle operated on, I discussed my issues with the Anaesthetist, and he was completely willing to skip the tube. Instead I had a spinal block and then IV sedatives. I was completely out for the surgery and felt it was a very sucessful solution.

Good luck!

[gurs]

yes, please make sure  you talk to the Anaesthetist and MAKE him aware of just how dry you are..tell him you cannot swallow at all basically..Most of them have no clue just
how dry we are/or we can get..I think they use childrens tubes on me the doc's have told me. I also drink water in the AM before any procedures-surgeries regardless of
what they tell me..Im always so dehydrated no matter how much water I drink and that certainly helps. Im not saying this is best for you, but with my dryness, this seems
to work well.

[Julie]

Thank you all for your replies.  It helps so much to hear from others.  I was hoping to get to talk to an anesthesiologist before the pretesting day, but they said they

don't usually take appointments like that and that they don't know which one is working that day that far in advance.  So, I guess if it feels like my concerns seem

to be falling on deaf ears or I do not feel comfortable about the whole thing when I do finally talk to him, I will cancel and look at going to another hospital for the

procedure.  I sure like the weather of the South and the humidity it provides for my dryness, but right now I'm wishing that we were back up near the Cleveland

Clinic for this.

Nurses, can you please tell me more specifically the purpose of the intubation tube?  I know it's to keep airways open, but what would cause them NOT to stay

open on their own?  If I didn't have the tube, do you think I'd be in jeopardy because of the mucus that I have from the dryness?

I have been reading about the different types of anesthesias too.  It seems many of the general anesthesias still have the 'esthers' which I have trouble with in

local anesthesias.  And...with my lung and nerve problems, I have trouble breathing in chemicals without reactions.  I will have to talk to them about the possibility

of anesthesia by IV.   

Right now I am battling a very inflamed, painful sty.  It finally started draining this morning so I am feeling some relief.  I usually have a high tolerance for pain, but

this thing burned like someone laid a hot curling iron on it.   

It's ALWAYS something, isn't it! ? !

Take care
Julie

[Linda196]

Intubation has the potential for a bit more than keeping the airways open, although for simple anaesthetic that may be the whole purpose. During even mild anaesthetic the throat, pharynx and larynx can become very relaxed and close, and the tube is a simple prop to prevent that.

Depending on the type of general anaesthetic, you may also receive a paralyzing agent...not uncommon in abdominal surgery of any type to relax the strong abdominal muscles and allow better access, even when done laproscopically. This agent can also paralyze the respiratory muscles, and the tube in that case is access for measured breaths from a ventilator.

Another possibility is the need for clearing the secretions from the airway and lungs, especially in the case of regurgitation of stomach contents (one of the primary reasons for taking nothing , even water, by mouth before an anaesthetics) because they can settle in and cause aspiration pneumonia.

The tube can also be helpful to the anaesthetist in monitoring the patient's condition, since it can provide accurate measurements of rate and volume of breaths, levels of O2 and CO2, and any increase in the resistance and/or the capacity of the lungs.

A fourth, remote possibility is preparedness for any emergency that may occur during surgery.

[Julie]

Linda, Thank you so much for the thorough explanation.  It sounds like it is probably safer to have the tube, although I am still very concerned about them tearing something trying to get it in and out.

I went in for pretesting yesterday. They weren't going to let me talk to an anesthesiologist! I told them there is NO WAY that I will have this surgery if I can't talk to one in advance.  The nurse was very understanding and was able to have one of them come in and talk to me.  He was very helpful in listening to my concerns, actually read over the page long history sheet that I take with me to all of my appts, (which is a rarity) and tried to calm my fears.  Just as I was feeling a "tiny" bit more relaxed, he said he will not be working next week when I have the surgery. Oh no!!!  They have a team of 15 anesthesiologists, and it's whoever is on the schedule for the day.

He wrote down notes and my preferences/requests and said the one on duty would read them and take good care of me.  I pray that will be the case.  I was shaking like a leaf from nerves while at the hospital yesterday.  And..it was ice cold in there.  I told the nurse I don't know what I'm suppose to do about dealing with the Raynaud's during surgery. I hope they pile tons of blankets on me. That's the least of my concerns, but when I lose feeling from Raynauds, it makes my heart go wacky too.  Loved how they had to have a urine specimen to make sure I'm not pregnant when here I am age 52 and had just started my period the day before.  Gotta love the protocol.  lol  I haven't heard back on my labs yet.  With this chronic anemia, I hope I won't have to have transfusions.

Thanks for all of the input everyone.

Take care
Julie




 

[JannaLee]

Good luck, Julie!

Sending my support and wishes for the other anesthesiologist to READ your message!

Janna

[irish]

Julie, When you go in for your surgery take along a print out of your medications and on this write in about the need for warming blankets to keep you warm due to disease process.

Also, write down about your sjogrens and extreme dryness and being told that you have a narrow airway. Usually the anesthesia people will have your open your mouth or at least talk to you before surgery. Things have improved so much with anesthesia in the past few years and they are able to accommodate so many more health issues. I know you are scared but it is good to have some fear prior to surgery. Anyone who says they aren't scared or having anxious moments probably doesn't understand the situation.

Just know that it helps to write this down and have it all on this sheet with list of meds. I have found that the nurses refer to this a lot. I usually will print off the meds and the last time I took a dose. They ask this frequently and it can be time consuming so the print out helps.

I have issues with over sedation with anesthesia because I am so sensitive to morphine or fentenyl. The anesthesia people are always informed of this many times by me when I go in for surgery. It is also good if you can have your surgeries mostly in the same hospital. This way the anesthesia people have records to refer to. Good luck. Things will be fine. Also, lubricant is used on intubation much of the time because of the dryness people suffer from lask of fluids pre-op. Also, the drugs they give you in surgery make you dry also.

They have different sized tubes with which to intubate you. Some adults need to have a child's tube used due to small mouth. Irish

[Epson]

I have had a number of procedures in just the last two years and I'm going to have another next friday.  I have always had trouble with intubation, I even have a letter from an anastesiologist that states that a glidascope be used for intubation.  The problem has nothing to do with my dryness or difficulty in swallowing, but physeology does, which might explain my sleep apnea as well.