Selma Calmes, MD, (ret) anesthesiologist
1. Post-polio patients are nearly always very sensitive to sedative meds, and emergence can be prolonged. This is probably due to central neuronal changes, especially in the Reticular Activating System, from the original disease.
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In mid-August 2016, I bumped my right elbow on the bar of my wheelchair, and it hurt a lot for a few days. But it wasn’t till late September that I developed a bursa. The nurse practitioner at our doctor’s office drained it, but it filled back up. When I went there the following week she didn’t want to drain it again without sending me to an orthopedist.
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Selma H. Calmes, MD, anesthesiologist (retired), Olive View/UCLA Medical Center, Sylmar, California
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Lawrence C. Becker, Ventilator-Assisted Living, Fall 2003, Vol. 17, No. 3
After 45 post-polio years of avoiding surgery altogether, I have recently been forced into two significant surgical procedures. One was an emergency gallbladder operation (1999), performed laparoscopically under general anesthesia in a small community hospital.
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Mickie McGraw, Ventilator-Assisted Living, Volume 29, Number 4
Over the past ten years, I have faced several surgeries including gall bladder removal, a mastectomy and kidney stone removal. As a person with significant respiratory weakness resulting from polio, I often found I had more concerns about complications related to my breathing than most other aspects of the surgeries. I contracted polio in 1953 and have used some sort of nocturnal ventilation from the outset - I currently use a PLV-100 positive pressure ventilator with an Oracle face mask to sleep.
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Selma Harrison Calmes MD, Retired Clinical Professor of Anesthesiology, UCLA School of Medicine
INTRODUCTION:
This talk * will briefly review the process of anesthesia care, current anesthesia practice, and how these might relate to post-polio syndrome (PPS) patients having surgery. The goal is to make clear that proper preop planning allows post-polio patients to have surgery and anesthesia with a minimum of risk. Indeed, the risk of anesthesia is much, much less than the risk of death from an error while hospitalized.
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Why is it so hard to link up ahead of time with the anesthesiologist who will do my case?
Daily anesthesia staffing is a complex equation! It is extremely difficult to know ahead of time who will be doing which case on a particular day. There is a constant flux of anesthesia staff (people get sick), other needed staff such as techs, incoming emergency cases, obstetric anesthesia cases, cases may move from one OR to another and so on. And, anesthesia group size is increasing; it is not unusual to have groups of over 100 anesthesiologists.
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What’s new in anesthesia that I need to know?
This is a brief listing. Answers will be expanded as time allows in the session.
a. Better measurement of quality of care in anesthesia and better recognition of where problems are and how they could be improved.
b. Increasingly sophisticated knowledge of ventilation problems and better management of respiratory problems postop.
c. Recognition that many patients are left with residual neuromuscular block and the possible complications.
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What are the issues in bariatric (intestinal surgery that can facilitate weight loss) surgery for post-polio patients?
This sounds like a “quick fix” for obesity but is an area full of possible problems. There are no reports of post-polio patients having bariatric surgery.
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“Do I really need to have a colonoscopy? It requires anesthesia, and I’m afraid of that.”
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