Successful Intubation and Anesthesia

Every two years I have to get minor outpatient surgery to change my peg g-tube. This unfortunately has to be performed in the main operating room in the hospital so I can be intubated and properly monitored.

It’s supposed to be a quick, routine procedure that’s only about 15 minutes long. That doesn’t sound too bad, right? But changing my g-tube isn’t the hard part or the one that causes me the most anxiety.

Challenges with intubation and respiratory issues

Anybody with SMA knows that we’re typically a tough patient to intubate considering our respiratory issues as well as the fact that our mouth doesn’t open very wide. However, in the past, I’ve luckily never had problems with intubating or extubating until my last g-tube change in 2020.

Before any surgery, the anesthesiologist should talk with you while you wait to be brought to the OR. During this time, I always explain SMA and the corresponding respiratory problems like how I use BiPAP to sleep and will need it when I wake up from the anesthesia.

I also demonstrate how wide I can open my mouth which isn’t very wide compared to a standard patient and suggest they review previous surgeries in my chart to see what has been successfully done before.

Issues with anesthesia and waking up during surgery

Although the most arrogant of all doctors, anesthesiologists usually listen well and do a great job with me. However, in 2020 I should’ve known there’d be problems since that anesthesiologist was going rogue before I even got into the OR. He wouldn’t read past surgical reports or listen to what my parents or I were saying.

During the surgery, I woke up while he was still trying to intubate me and started freaking out because I couldn’t breathe. The OR team noticed and quickly put me back to sleep within seconds but it was still a very scary moment that could’ve been avoided. On top of that, it took over an hour to get me properly intubated.

Stress and anxiety after this procedure

In hindsight, I should’ve requested a different anesthesiologist in pre-op as soon as he made me feel uncomfortable. My surgeon ended up reporting this anesthesiologist.

When my two years started to approach this past March, I of course became extremely anxious wondering if the same thing would happen again. Maybe it wasn’t the anesthesiologist. Maybe I’m just impossible to intubate now.

A doctor who advocates for my needs

But my GI doctor who performs the surgery assured me that he would make sure a situation like that never happened again. He reached out to two other anesthesiologists who had successfully worked with me in the past to research the difference between procedures.

We found out that I always get intubated using fiber-optics, however, the last anesthesiologist tried a different approach because he wasn’t familiar or trained with what works for me. A good anesthesiologist would’ve stepped away from my case and passed it to someone who is more qualified.

When scheduling my surgery, my doctor put in a request to have one of the anesthesiologists who are familiar with me or someone trained in fiber-optics. The hospitals are usually good about honoring requests.

Preparation for a better experience

Because of what happened last time, the anesthesiologist called me the night before my procedure to discuss my case and SMA and also to brag about how he teaches the fiber-optics class (classic anesthesiologist move).

But, he gave me peace of mind that everything was under control and would go smoothly. And it did!

I was in and out with a brand new tube in less than thirty minutes and, most importantly, didn’t wake up during the surgery. This is a testament to my GI doctor advocating for me and empathizing with what previously happened.

Surround yourself with doctors who have your back. And never be afraid to speak up and tell any type of doctor what does or doesn’t work for you.