Considerations For Surgery For 16 Year Old With Pots

[paona]

My daughter is having a minor surgical procedure done next week and will be put out for 45 mn. She will not be opened up so will not have that added stress to the body. I came across an article on general management of general anesthesia in a patient with POTS and will bring a copy of that with to the hospital. They are aware that she has POTS and it is a hospital with an excellent reputation. They said a nurse would be calling a few days before and the anesthesiologist will talk to us before the surgery. This is the site of the article: http://www.ispub.com...a-syndrome.html

I will be talking to them about whether she should get her beta blocker and fludrocort before the surgery (pamphlet mentioned needed meds could be taken with one sip of water). The surgery is scheduled for 7:30 a.m. so she could take the meds after. The clinic also mentioned that someone informed them that my daughter would need additional recovery cortisone since she is on fludrocort. I'll address that when they call. I will be sure that she gets lots of I.V. saline. Any other suggestions? She is basically doing well healthwise but like others with POTS she has a good chance of it being set off if she follows her typical pattern. Any other suggestions?

[kclynn]

No suggestions, but thanks for the great link! Handy one to have bookmarked or even keep in the medical file, just in case.

[roxie]

Hi paona! I don't know a lot about what to say for the beta blocker/florinef/cortisone. I know saline can't hurt! 

I've "gone under" a few times since having POTS. 

-I have always asked for no epinephrine 

- And I'm sensitive to meds so they have always used the smallest dose they could. When I had my upper GI they used a baby dose but had more there if needed. 

I also had surgery for a ruptured ovarian cyst. I really don't know about the  anesthesia at that time because it was sort of emergency surgery.

-I do know that she will probably feel awful, so take it slow and don't

expect her to wake up and be back to her normal self as quickly as a healthy person would.

-I've always felt shaky and weak after being knocked out. 

-Dr 's have never been crazy about giving me strong pain meds, so I try my best to go without and use ibuprofen or Tylenol & ice/heat.  But that depends on the situation too. Talk to the dr about that.   

[paona]

Just got back from pre-op examine for her surgery on Thurs. Just wanted to let others know instructions that were given by her primary physician to help her get through surgery. First he said to now start having her drink lots of gatorade or pedialite (she can't because she's allergic to dyes but we use Electro Mix packets in her water). She already drinks 12 cups of water a day but he wanted her to get extra electrolytes. He said that it was very important for her to take her metoprolol tartrate (beta-blocker) before her 7:30 a.m. surgery so she is to have one sip of water and take this. He said the beta blocker was important because normally the heart rate goes up during surgery. He said that she is not to take her fludrocort before surgery but gave instructions for her to be given 100 mg of hydrocortisone(I.V.) to keep her blood pressure from dropping, and will have a saline solution as well. Today her blood pressure was 91/50 and heart rate while sitting was at 54 and she is feeling well. Just wanted to share these suggestions for surgery. Also she will only be out about 45 mn. and hopefully won't have to be over medicated.

[sandymbme]

I am having surgery on Thursday, and as my surgeon was not very familiar with POTS, he sent me for cardiac clearance before he would clear me for the surgery. (I am having an arthroscopic repair of a torn labrum in my left hip, which is the cartilage that holds the thighbone in the hip socket.) I have EDS-III, so no fall or any accident, I just was stuck sitting in a plane for 6 hours, and when the flight finally arrived, after a 3 hour delay they kept us on board for, in Milwaukee I couldn't walk.

Anyway, I have had several surgeries in the last few years, and I really haven't had any major problems. We usually withhold my beta blocker that morning, because I tend to be very hypotensive. The cardiologist I saw told me not to take any of my meds that morning, but to bring my midodrine with me. He also said that he was going to advise the anesthesiologist run a lot of fluids in me, and that they not discharge me without getting a set of good orthostatic pressures that show I am fairly stable. And as a precaution, we are not doing my surgery in the surgical center they normally use, but are doing it in a regular hospital instead.

I think that the pre-surgical directions can vary a great deal among us, given how much variance in symptoms we all have. The important thing is to make sure your surgeon and anesthesiologist are aware of your POTS or any other serious health conditions you may have, so they can consult with your doctors and have the best plan possible for you. That said, paona, it sounds like you have dotted all the i's and crossed all the t's, so your daughter should do fine. Especially since they can do it without needing to cut her open. Many of us POTSies tend to heal very slowly, so don't be surprised if her recovery takes longer than they expect, or at least longer than the "average" patient. Also, I was warned not to use any NSAID's (non-steroidal anti-inflammatory drugs like advil, aleve, ketoprofen, motrin, etc.) because they can cause bleeding complications. So if that wasn't a direction you were given for your daughter, call the doctor and check first thing. And good luck!

Sandy