Thanks again for the new comments.
I faxed the following to the anesthesiologist today. The nurse called me back and said that the doctor will call me tomorrow. She did answer one of the questions I had. They do not use epidurals at all for this type of procedure, open or not. That's interesting because from the journal article it sounds like it is standard for open surgery colectomies.
PRE-SURGERY QUESTIONS FOR ANESTHIOLOGIST
First, before I get into my questions, I want to make note of a couple things:
• First, my records at svhealthcare.org have varying notation about the local anesthetic I have adverse reaction to. It is any local anesthesia that contains epinephrine.
• Second, I have a varicose vein in my right calf that has worsened over the past month. That fact is not in my records.
The following questions have been derived from Anesthesia and perioperative management of colorectal surgical patients – A clinical review. J Anaesthesiol Clin Pharmacol. 2012 Apr-Jun; 28(2): 162–171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339719/
1. Do you plan on doing an epidural? At what block height? I am not sure how likely conversion to open surgery is, but I know from Dr. Cope that it is a possibility. The journal article recommends inserting an epidural catheter if conversion to open surgery is likely. The article also reports that intraoperative thoracic epidural anesthesia and analgesia has been associated with an increase in colonic blood flow and better gastrointestinal recovery.
2. Continuous spinal anesthesia using microcatheter is used for high-risk patients. Although Dr. Rogge noted in his cardiac catheterization report that I will likely tolerate the surgery well, I am not exactly a “low risk” patient due to:
* BMI of 35,
* hemoglobin ranging from 7 to 9 (his last transfusion was 4/12/17 and CBC on 5/2/17),
* low hematocrit,
* elevated NTproBNP,
* 40% occlusion at 1st septal perforator of LAD,
* low left ejection fraction of 40%,
* diffuse dilated cardiomyopathy,
* diffuse hypokinesis and diffuse reduction in wall thickening in LV wall,
* high blood glucose/diabetes, etc.
The article notes that a wide variety of CR surgical procedures are performed with anesthetic block height T6-T7. After establishing spinal anesthesia with heavy 0.5% bupivacaine and fentanyl, 0.5% isobaric bupivacaine was used to extend spinal anesthesia. However, the microcatheter was removed at the end of surgery. If this is something that will be done, what exactly is planned?
3. What specific anesthetic or analgesic agents are planned for laparoscopic surgery? For open? If the surgery gets converted from laparoscopic to open, will there be a need to change anesthesia to address the change?
4. Will you use neostigmine aka Prostigmin? I hope not.
5. What is planned for goal-directed hemodynamic management?
6. Will you be monitoring central venous oxygen saturation (ScvO2) intro-operatively and post-operatively?
7. Will you administer dopexamine? If so, at what dosage mcg/ kg/min?
8. Will restrictive fluid therapy be used during the postoperative period?
9. Is a “nil by mouth” until flatus has been passed or bowel sounds heard strategy planned?
10. How many hours post-surgery will enteral nutrition be allowed?
11. What post-operative pain management is planned if the surgery is laparoscopic? Open?