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Anesthesia and LEMS, My Recent Experience
This very brief article on LEMS patients and anesthesia introduces some factors we should be aware of. After you take a moment to read it, come back and read about my recent experience with general anesthesia.
Two weeks ago I had eye surgery involving the retina in my left eye. While discussing the surgery with my surgeon, the degree of sedation was discussed. Nothing was decided, and the options were moderate sedation or full, general anesthesia. From my perspective, it was the choice of being fully asleep during the surgery vs an easier recovery after surgery. I was unsure. As LEMS patients we should always discuss having a myasthenic disorder with the anesthesiologist before surgery.
Pre-surgery the first physician who came to my bedside was the anesthesiologist. We had a long conversation, and she told me they were prepared to do a general. She did say she would do a MAC (moderate sedation), if that’s what I wanted. I didn’t make the final decision until I was in the OR being positioned. I decided on the general, despite what we know can happen. I’ve had a general a couple of times in the past few years with no major problems. With the nurse anesthetist at my head with the mask, and the anesthesiologist pushing meds, I went to sleep quickly.
How did it go? First, I’m very happy the surgery to my retina was done completely without my awareness. That was the big payoff of general anesthesia. My pacemaker was placed under moderate sedation, and though I didn’t remember everything, I was partially aware when some things happened. Post surgery I awakened with an oxygen mask on and a slight bit of extra effort taking breaths. As I further awakened the mask was removed and my breathing recovered to what felt normal relatively quickly. In all, I spent almost two hours in recovery, primarily because of high blood pressure which had to be controlled before I could leave recovery. I place the cause as my dysautonomia. All in all, I feel I made the right decision in hindsight.
If you’ve had experience with anesthesia and your LEMS, please tell us about it in the comments.
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2 Replies
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Thank you for sharing your experience. 3 years ago I had surgery that was going to be “same day”. I was not diagnosed with LEMS at that point. I thought I was just very sensitive to anesthesia but now wonder if it was LEMS. I had some symptoms of it at the time, so maybe it was in the beginning stages. In any event, I could not “come out of it” for a long time. I would not rouse after and kept going back to sleep. I couldn’t get up out of the bed and was completely exhausted. Needless to say, I stayed over and didn’t leave the hospital until the afternoon the next day.
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@michellekeogh thanks for telling your experience with a general. It sounds more difficult than I experienced. Once I awakened I became lucid and awake fairly smoothly. I did think when I initially awoke it was more difficult to pull a breath (diaphragm issue?), but it resolved quickly. I went through all this with my pulmonologist Tuesday, and he seemed to understand and concur on the possible reason.
Everything we’re saying here underscores the importance of working with your anesthesiologist team for the best outcome.
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