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#195567 - 01/04/18 06:56 PM General anesthesia/Intubation  
Joined: Oct 2008
Posts: 221
travelottie Offline
Gold Member (200+ posts)
travelottie  Offline
Gold Member (200+ posts)

Joined: Oct 2008
Posts: 221
NY state
My husband is 10 yrs post treatment. He has had one dental extraction with delayed healing, leading to debridement of a section of mandible (possible early stage ORN which has remained stable for over a year), increasing difficulty swallowing (swallow test performed--cough reflex remain adequate), etc. We are now on to the next complication...He needs surgery for a kidney stone and general anesthesia is being recommended by the urologist. I am concerned about intubation post radiation. He was intubated once for oral surgery, but that was done by an oral cancer team so I was confident in their skill.

Other than consulting with anesthesiologist and alerting everyone to these issues, is there anything else I should consider? I plan to discuss situation with ENT and hematologist/oncologist. Primary care physician has suggested checking into spinal anesthesia.

Anyone have insight or experience with intubation post radiation therapy?


CG to husband, dx @ age 65, nonsmoker/social drinker. Dx 5/08 SCC Stage IV, BOT T1N2aM0. 33 IMRT - completed 9/12/08. Induction Chemo (Cisplatin, Taxotere & 5FU), plus concurrent Cisplatin.
1/09 PEG removed; 5/09 neg PET/CT; 5/10 PET/CT NED
Dental extraction & HBOT 2013; ORN 2014; Debridement/Tissue Transfer & HBOT 2016
#195569 - 01/04/18 10:14 PM Re: General anesthesia/Intubation [Re: travelottie]  
Joined: Jul 2012
Posts: 3,099
PaulB Offline
Patient Advocate (old timer, 2000 posts)
PaulB  Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jul 2012
Posts: 3,099
NYC
Hi, and Happy New Year Travelottie!

I’m sorry for the new troubles! As far as anesthesia, I’ve had it multiple times, including for a Mandibulectomy. A few times the anesthesiologist intubated me nasally due to trismus while being awake, not really as they sedated me, and was knocked out!

The last time for the fibula reconstruction the anesthesiologist and plastic surgeon, who was partnered with my ENT for the jaw surgery, felt it was possible, and best to use twilight anesthesia to reduce possible complications associated with general anesthesia due to my history, and high creatinine/low GFR.

I did have my peg removed by the gastrologist, not at the CCC though, in 2013, and was awakened from twilight anesthesia by pain from them pulling it out through my mouth, had had to be held me down by three of them, and given more IV sedation. They did find I have barrets esophagus, so unfortunately, I need yearly endoscopes, plus doing a few dialations since. I told every single person at the local hospital involved about my history, and pain incident, and again before being fully sedated, they put this plastic mouth donut plug in my mouth again to access the throat, and hurt so much I was held down again, and quickly given more IV sedation. This was before my ORN surgery, at which time my ENT said my jaw was fractured when it wasn’t before. It could have been from the ORN itself, but I didn’t rule out it was from the endoscopy.

I’ve had kidney stone surgery probably in 2011 where they lasered them, put in a stent. I don’t remember what type anesthesia I had.

Other than that, I’ve heard of acupuncture for some surgeries, not sure of the type surgery though.


10/09 T1N2bM0 Tonsil
11/09 Taxotere Cisplation 5-FU 6 Months Hosp
01/11 35 IMRT 70Gy 7 Weeks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 weeks Taxotere Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Removed IORT 10Gy PNI
12/13 25 Proton Therapy 50Gy 6 weeks Carboplatin
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fibular Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent






#195573 - 01/04/18 11:07 PM Re: General anesthesia/Intubation [Re: travelottie]  
Joined: Jun 2007
Posts: 9,990
ChristineB Offline
Administrator, Director of Patient Support Services
ChristineB  Offline
Administrator, Director of Patient Support Services
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 9,990
PA
Im very sorry to read about your husbands continuing post rads issues. Ive had several surgeries since the mandibulectomies in 2009. I always end up having a long chat with the anesthesiologist during my per-admission testing. I was surprised every anesthesiologist Ive met with over the years has been able to put me out by putting very thin tube up my nose and down my throat. Having severe trismus, I was surprised this was able to be done. I was only partially awake when this was done once and I barely remember it as I was already pretty groggy by what they gave me thru my IV.

I suggest speaking to the surgeon at length and also the anesthesiologist. They will need your husbands history and to know all about any post rads issues he may have besides the obvious, what hes having surgery for.

Best wishes with the upcoming surgery!!! Pleas let us know how your husband makes out and how he did with the anesthesiologist.


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
#195575 - 01/05/18 02:03 PM Re: General anesthesia/Intubation [Re: ChristineB]  
Joined: Oct 2008
Posts: 221
travelottie Offline
Gold Member (200+ posts)
travelottie  Offline
Gold Member (200+ posts)

Joined: Oct 2008
Posts: 221
NY state
Thank you Christine and Paul. It is comforting to hear back from caring forum members.

I have already alerted all the MDs involved to Bob's history. I will make certain that we have a comprehensive evaluation by the anesthesia department and not just a cursory exam. I forgot about possibility of nasal intubation.

I will wait and see what plan is suggested before I panic. It's easy to overreact when you've been through so much, things are stable, and you are trying to avoid another set of complications...

Happy New Year,
Lottie


CG to husband, dx @ age 65, nonsmoker/social drinker. Dx 5/08 SCC Stage IV, BOT T1N2aM0. 33 IMRT - completed 9/12/08. Induction Chemo (Cisplatin, Taxotere & 5FU), plus concurrent Cisplatin.
1/09 PEG removed; 5/09 neg PET/CT; 5/10 PET/CT NED
Dental extraction & HBOT 2013; ORN 2014; Debridement/Tissue Transfer & HBOT 2016
#195577 - 01/05/18 09:50 PM Re: General anesthesia/Intubation [Re: travelottie]  
Joined: Jun 2013
Posts: 140
KristenS Offline
Senior Member (100+ posts)
KristenS  Offline
Senior Member (100+ posts)

Joined: Jun 2013
Posts: 140
alabama
Gah, this makes me realize how many MORE questions we should have asked before my recent oral surgery. (The dental extractions.) On the plus side, I know they did the tube down my throat (because it hurt like the dickens afterwards) and as far as I can tell, there were no complications from it that were any worse than my continuing reflux problems post-radiation. Will that help reassure you? I'm in the headed-for-dentures process right now, healing and waiting to be ready for molds, so probably not as far along as your husband is, but the tube wasn't as bad as it could have been. Though it did hurt more than I recall it hurting after surgeries pre-radiation.

Kristen


Surgery 5/31/13
Tongue lesion, right side
SCC, HPV+, poorly differentiated
T1N0 based on biopsy and scan
Selective neck dissection 8/27/13, clear nodes
12/2/13 follow-up with concerns
12/3/13 biopsy, surgery, cancer returned
1/8/14 Port installed
PEG installed
Chemo and rads
2/14/14 halfway through carboplatin/taxotere and rads
March '14, Tx done, port out w/ complications, PEG out in June
2017: probable trigeminal neuralgia
Fall 2017: HBOT
Jan 18: oral surgery
#195626 - 01/24/18 04:21 PM Re: General anesthesia/Intubation [Re: travelottie]  
Joined: Oct 2008
Posts: 221
travelottie Offline
Gold Member (200+ posts)
travelottie  Offline
Gold Member (200+ posts)

Joined: Oct 2008
Posts: 221
NY state
Updating after surgery:
It took persistence on my part, but I did get anesthiologist to stop and listen to my concerns regarding intubation. They used a small size flexible tube with no problem. The RN anesthetist payed more attention and checked mouth opening and neck restrictions. That's when I knew it would be ok.

I wrote a note for recovery room to withhold oral liquids until fully awake, sitting up, and able to produce a vigorous cough.

Unfortunetly, problem was encountered reaching the kidney stone with laser equipment (happens in 5% of cases) so has to be repeated in 2 wks, but that's another story. On the one hand, this is minor compared to cancer and its tx., but we do feel increasing vulnerability with each subsequent medical issues.


CG to husband, dx @ age 65, nonsmoker/social drinker. Dx 5/08 SCC Stage IV, BOT T1N2aM0. 33 IMRT - completed 9/12/08. Induction Chemo (Cisplatin, Taxotere & 5FU), plus concurrent Cisplatin.
1/09 PEG removed; 5/09 neg PET/CT; 5/10 PET/CT NED
Dental extraction & HBOT 2013; ORN 2014; Debridement/Tissue Transfer & HBOT 2016
#195627 - 01/24/18 04:49 PM Re: General anesthesia/Intubation [Re: travelottie]  
Joined: Jun 2007
Posts: 9,990
ChristineB Offline
Administrator, Director of Patient Support Services
ChristineB  Offline
Administrator, Director of Patient Support Services
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 9,990
PA
Thanks for the update. Too bad about not being a successful removal of the kidney stones. Hope next time works and is easier.


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
#195628 - 01/24/18 05:19 PM Re: General anesthesia/Intubation [Re: travelottie]  
Joined: Oct 2012
Posts: 947
gmcraft Offline
"OCF Canuck"
gmcraft  Offline
"OCF Canuck"
"Above & Beyond" Member (500+ posts)

Joined: Oct 2012
Posts: 947
Toronto, Canada
Sorry about the need to repeat the surgery, but you truly did a fantastic job as a caregiver.


Gloria
She stood in the storm, and when the wind did not blow her way, she adjusted her sails... Elizabeth Edwards

Wife to John,dx 10/2012, BOT, HPV+, T3N2MO, RAD 70 gy,Cisplatinx2 , PEG in Dec 6, 2012, dx dvt in both legs after second chemo session, Apr 03/13 NED, July 2013 met to lungs, Phase 1 immunotherapy trial Jan 18/14 to July/14. Taxol/carboplatin July/14. Esophagus re-opened Oct 14. PEG out April 8, 2015. Phase 2 trial of Selinexor April to July 2015. At peace Jan 15, 2016.

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