Surgery Meds/Anesthesia

macdebbie

So, I finally saw the breast surgeon Monday and absolutely love her. She spent a lot of time with me answering my many questions.

Because I have a really complicated history with meds and seem to have a reaction to everything, I wanted to be clear what meds she uses during the surgery. I will be having a lumpectomy.

She told me that she uses propofol, which I have had before for colonoscopies and done fine with. Then she told me she (or the anesthesiologist) uses steroids for prevention of Lyngospasm, which she said could be life threatening, I have never heard of this before, and it's cause my stress level to go up for two reasons. One, of course that that is a possibility, and two, because I am pre-diabetic and my endocrinologist told me that I should never, ever, have steroids, even in the ER unless my life was in danger and there was "no other way" because giving me steroids could put me into full blown diabetes.

I have worked really hard the last 7 years to eat an "almost" keto diet, which has been tough, but I wanted to stay off meds and stabilize my blood sugar. I am distraught that all my efforts could be ruined now because of this steroid given during surgery.

Is anyone familiar with this and do you know if there is any alternative I can discuss with the surgeon?

Also, the breast surgeon never did a physical exam of my breasts. I don't know if she was pressed for time or just forgot and I was so distraught after hearing about the steroids I completed forgot about it. I have a pre-op visit with the PA on the 30th. Should I just have her do it or is it important for the surgeon to do it?

AliceBastable

I am diabetic, and was pre-diabetic before that, and I have never heard that about steroids. They have had absolutely no affect on my diabetic status when I've had them, and I've had a lot of surgeries over the years. Can you check further on what that endocrinologist said? LOTS of people with pre-diabetes and diabetes have surgery every day and if it was a huge issue, it seems like surgeons and anesthesiologists would be aware of it.

Betrayal

You can ask to speak to the anesthesiologist about your concerns. If steroids are used it would be low dose and should not have an impact on your diabetes. As far as the breast exam, I remember my BS showing me the mammo films to discuss the surgery plan but I had a non-palpable mass so he did not really examine me. You can discuss this with the PA to learn more about what the pre-op plan for the lumpectomy will be. Good luck.

macdebbie

Hi AliceBastable - My end said this - that if I were ever to go to ER there may be an occasion that they would want to give me steroids because their job is to make me feel better. He told me that steroids could "push me over the edge" into full-blown diabetes and so to ask them (unless it was a a life-threatening situation) if there was ANY way to not use steroids. He was emphatic about it. I looked it up, and there is something called "Steroid-induced diabetes". They said sometimes it resolves, but in some cases it does not. I also reached out to the admin of a Keto Diabetes FB group I am in and they told me I could have high blood sugar for several weeks as a result of being given steroids. My breast surgeon said the increase would last @ 6 hours. So kind of all over the map. I suppose it depends on the person. I will speak to the anesthesiologist about it.

Betrayal - Thanks for the info. I will mention the exam at my pre-op and check again about the steroid use during the pre-op as well and also with the anesthesiologist.

moth

macdebbie, see the thing is, anasthetists (anas) are the bosses on this, not the surgeon. Honestly, I'm not sure your BS gave you the correct info. SHE wouldn't use anything. The ana does. It's the ana's choice what to use to sedate and immobilize and at what dosage. The surgeon and ana co-ordinate on pain management (injection of local would be the surgeon but injection of system pain meds, patches, or using a nerve block would be the ana's job).

Usually here, once you're admitted, the anasthetist comes out and does their own in person pre-assessment (they'd have read the file before) and you can mention whatever issues you have (like nausea post op or resistance to opioids etc or the reluctance to use steroids in your case) and they will work with that.

fwiw, I've not heard of steroids being used routinely for laryngospasm and so I had a quick look and the only mention of it is for pediatric cases in some surgeries https://medcraveonline.com/JACCOA/update-on-the-ma...

I hope this all turns out to be a big nothing that has worried you needlessly.

EDITED TO ADD: I asked someone who works in post anesthesia care and her pts routinely have had dexamethasone and zofran intra operatively for nausea prevention. So if it's only being used for anti nausea, you could request to skip the dex and just hope you're not going to be heaving too much after. She also said you could ask your surgeon to request an anasthesia consult.

jhl

Hi Macdebbie,

Yes, one steroid dose is usual during surgery that requires general or MAC intubation. However, one steroid dose will not tip you over to becoming diabetic. Exogenous steroids will indeed increase your blood sugar but a transient increased blood sugar is not diagnostic for diabetes. The intraoperative steroid is used for several reasons, the first one being what your surgeon suggested, which is to reduce the potentially lethal risk of laryngospasm. But, it also helps with nausea upon emergence. It is important to think about physiology when it comes to surgery and also diabetes. With diabetes, your pancreas has difficulty releasing enough insulin to keep up with your blood sugar. Your muscles also have difficulty using both the glucose & insulin properly. You have been able to keep these in check enough to not require intervention and your physiology will not change with surgery. Now, with regard to surgery or any other major physical insult to your body, your adrenal glands automatically increase your endogenous steroid production to deal with the insult. As a matter of fact, just the normal anxiety produced by waiting for & preparing for surgery has already increased your blood sugar without you even knowing. These are normal protective effects.

All this is to say, one dose of dexamethasone which is usually used during the course of anesthesia will not change your physiology. Your endocrinologist was simplistic in saying don't take steroids. I'm guessing he doesn't want you to take a prednisone taper or MedrolDosepak for a bout of poison ivy.

Try to relax & not worry. Your physicians want the very best outcome for you. Within a few days of your surgery, your blood sugars will be back to your normal.

I wish you the best,

Jane

macdebbie

Thank you moth. I was not sure who did what, and she may not have said she did these things, I am not sure. She did say that the anesthesiologist would have a phone call with me, which is I hope the case rather than what seems like at the last minute while I am lying on a gurney right before surgery. That doesn't seem to leave a lot of time to change plans if what they intend to do doesn't work for me.

I'm hoping it's nothing also, I've just had so many bad experiences in the last 5 years with meds where I have ended up in the ER due to someone not being careful and taking into my account my particular medical situation. I was surprised to hear about the lyrgospasm. I've never heard that before. I've had colonoscopies with propofol and wasn't told anything about that. Would surgery be different?

macdebbie

Thank you jhl. That makes me feel better. I was also told that they generally use an opioid during surgery, which I am not a big fan of, as I have read it doesn't take much to cause dependence, but the BS assured me that would not be a issue.

I'll just be glad when it's all over. I'm a horrible patient, mainly because I've had a lot of odd and frightening things go wrong with things normally given to other people without issue, and because a lot of doctors have disregarded my many medical conditions (diabetes, bradycardia, tachycardia, SVT, high blood pressure, chronic kidney disease stage II) and caused problems that ended me up in the ER.

Thanks again for the info.

Elizabett

My daughter is a juvenile type 1 diabetic for 20 years and. steroids will raise blood sugars but it's not a permanent problem. She has multiple health problems and on occasion has had to be put on a steroid. You are pre diabetic so just check your blood sugar but don't worry. Make sure you see an endocrinologist. Other doctors typically do not have enough training that's why there are endocrinologists. They know a lot about diabetes and it is very treatable. stress is bad for everything You are doing an amazing job sticking to the Keto diet / exercise and airing your concerns and getting answers is very health