Considering a tubal...

deepz · Jan 28, 2005

Brandy, it is possible to have your BTL under spinal but, for at least one reason it would prove to be suboptimal: insufflation of the abdomen leads to such pressure sensation referred usually to the sub-clavicular area. I've tried this approach in the past and had to put one (a control freak nurse) patient to sleep anyway, due to the pain.

You could check out having your BTL done in Scandanavia, where they save $ by doing these with local and sedation. !!!

deepz

Okay so I have been considering getting a BTL for a long time, but beng the typical control freak I want it done my way lol. well as far as the anesthesia goes.
So I have been told I HAVE to have a general, this does not make sense to me and the only reason I can come up with is that the recovery would take longer in the OP setting with a spinal/epidural.
So what I want is some information regarding the risks vs. benefits of general vs. regional specific for a BTL. That I can use to persuade a doc with lol. And if I am wrong and there is some MEDICAL reason for having to have a general I want to know that too.
Have any of you ever seen a BTL done this way? Any reason you would or would not suggest it?
Thanks in advance.
(hope this doesn't fall under trolling for healthcare, I really am just looking for education but let me know if you feel this is out of line)

BRANDY LPN · Jan 28, 2005

Hmm hadn't thought of that, keep it coming I really want to know as much abou tthis as I can.

skipaway · Jan 28, 2005

We did ours for a surgeon with local/sedation. It worked well. Propofol/Sufenta and just a very little Versed. I think patients get a little more out of control with larger doses of Versed. I usually try to limit it to 2-3mg and then rely on my other agents.

The physician uses local at the incision site, and then also localizes the tubes. Patients were very happy. Ask about it.

skipaway

BRANDY LPN · Jan 28, 2005

Thank you skipaway I will ask, I haven't set an appointment yet I am just now getting into the information gathering phase. I just hate the idea of all the risks involved with general for an elective procedure, which basically means Im a big chicken lol. I'm not a bit scared of the post op pain though, the only concern I have is the general, and would really like to eliminate it if I can.

So when you saw this local/sedation done did they use gas? and if not how does that effect the reliability of the procedure? Anyone have percentages of failure rates with the different methods?

jewelcutt · Jan 28, 2005

I don't think it has anything to do with failure of procedure or not, there are however, a thousand different ways to do anesthesia. There are people who are afraid of general, and those that absolutely refuse a spinal, all for their own reasons. I fall in the small group that doesn't want to know, be awake or cognisant at all, and is very afraid of pain (biggggg chicken!) whether I remember it or not, so for my own personal reasons i would never have local with sedation. It's funny how different people's views of anesthesia are. I had a man today that was getting a posterior lumbar lami and absolutely refused a spinal because he wanted to get out earlier that day and didn't want to wait around and pee. He had both a general and a spinal in the past and hated the spinal, so we did him with a general. I think if you talked to the anesthesia provider and discussed the possibilities and options you'll be satisfied with what you choose. You don't get gas with local and sedation, it's all IV.

deepz · Jan 28, 2005

.....You don't get gas with local and sedation, it's all IV.

My impression was that she was asking whether the abdomen was still insufflated with CO2. Yes, for a 'scope tubal cautery, it is.

jwk · Jan 28, 2005

Thank you skipaway I will ask, I haven't set an appointment yet I am just now getting into the information gathering phase. I just hate the idea of all the risks involved with general for an elective procedure, which basically means Im a big chicken lol. I'm not a bit scared of the post op pain though, the only concern I have is the general, and would really like to eliminate it if I can.
So when you saw this local/sedation done did they use gas? and if not how does that effect the reliability of the procedure? Anyone have percentages of failure rates with the different methods?

I've seen one local laparoscopy for a tubal. It was a lousy experience for all involved - patient and staff. Go with the general.

Of course no one has pointed out the other really obvious option - tell your husband to get a vasectomy. It's a truly minor procedure, especially compared to open or laparoscopic abdominal surgery, and absolutely zero risk from anesthesia - no regional, no MAC, no general.

It amazes me to watch some of these husbands in pre-op as their wives get ready for what truly is a surgical procedure with uncommon but very real and significant risks. Many of them have refused a vasectomy for some stupid reason, and the wife ends up having the big operation. What wimps. :crying2:

IMHO

skipaway · Jan 29, 2005

Of course no one has pointed out the other really obvious option - tell your husband to get a vasectomy. It's a truly minor procedure, especially compared to open or laparoscopic abdominal surgery, and absolutely zero risk from anesthesia - no regional, no MAC, no general.
It amazes me to watch some of these husbands in pre-op as their wives get ready for what truly is a surgical procedure with uncommon but very real and significant risks. Many of them have refused a vasectomy for some stupid reason, and the wife ends up having the big operation. What wimps.
IMHO

How refreshing JWK :yelclap:

skipaway

jewelcutt · Jan 29, 2005

Crap! I had a total brain fart and didn't even realize what she was asking :chuckle , I think I'm just really tired from clinical today and desparately need a drink :beer: Anyway, I know at my hospital we always tube a laparoscopic procedure, even though I know other places don't always. And ABSOLUTELY jwk, it is sooooooo astonishing how some women submit to having major surgery (when they already had to go through pregnancy, labor, or csection) just because of their husband's pride. Sorry if this sounds really opinionated guys, I just feel really strongly on it. Vasectomy is such a simple procedure with chance for reversal, I think it is very selfish to expect a wife go under the knife. Anyway have you guys seen the new smilies, my personal favorite being "beat the dead horse" :deadhorse , puke :puke: , and banghead :banghead: HA!

akcarmean, LPN · Jan 29, 2005

I had a tubal this summer and I reget getting it. My periods hurt worse and last longer; I am more moody, seem to bleed heavier. I should have made my dh do it.

Angie

apaisRN, RN, CRNA · Jan 29, 2005

My husband's dad is a urologist and my husband tells me "urologists don't get vasectomies." I don't know if this is true or not, or why it should be true. I don't think there are any big secrets about vasectomy that are kept from the public. My husband would of course prefer to avoid it but I think he would if it came down to it - the increased risks of female sterilization would persuade him. We're not even talking kids until after CRNA school and a few years of practice (and maybe not even then) so the topic won't come up for a few years.