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Elective surgery and IPF
Hello,
I have recently been diagnosed with IPF. Judging by my lung function tests and symptoms it is mild. Unfortunately I have also suffered a herniated lumbar disc (a ‘slipped’ disc) which requires minimally invasive surgery performed under general anaesthetic. The pain prevents me from walking very far.
I am worried about having surgery with IPF – the risks of pneumonia or developing a cough are my main concerns.
I know it is ultimately for me to decide what to do but any advice or information would be extremely helpful.
Many thanks
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8 Replies
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Given the risk of losing some lung function while under General Anesthesia, you are well served by seeking the advise of your pulmonologist before opting for your elective surgery.
Best wishes,
Jean Bordu
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This is personal opinion and not medical advice, but I n my decades as a CRNA, nurse anesthetist, I managed a fair number of PF patients, IPF and other forms. Mild IPF is usually straightforward, but still greater risk than generally healthy patients. Some back procedures can be done with regional anesthesia, epidurals, with sedation, but most are done under general anesthesia with a variety of techniques. In a prone position that nearly always requires that a breathing tube be placed after you lose consciousness. Probably the most common complication is delayed removal of the tube, that means that you might wake up on a ventilator until your breathing is adequate. It usually isn’t very long, but no guarantees. If that happens, you will likely be sedated during that time and might not remember it. Pneumonia and other respiratory issues are more of a postoperative complication and would be addressed as such.
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Hello David, Many thanks for your response. It seems that microdiscectomies can be carried out under epidural with sedation and I would prefer that to a GA but I live in the UK where GA seems to be used exclusively.
Do you know in what countries epidurals are used as an alternative to GA?
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While it might not feel good, postop deep breathing and coughing can be therapeutic for the lungs. Mention it to you pulmonologist, but anesthesia will probably ask for a pulmonary consult anyway.
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Jan. 2022, I had back surgery for spinal stenosis. Passed basic pre-surgery testing. 3 days after, I was in intensive care for 8 days. I got diagnosed with IPF. I have been on oxygen ever since. 4 liters at rest and 7 liters up walking. The intubation caused a serious flare up of the lung disease I never even knew I had. I will never be intubated again.
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Graham, I can’t help you with where to go for the epidural/local anesthesia options. In the US it varies from institution to institution and not all providers are comfortable with the options. It is a three way decision involving you, the anesthesia provider and the surgeon, so you need to talk to both of them. It would be beneficial if your pulmonologist suggested it also. Some interventional radiologists also do minimally invasive discectomies in the US, commonly under local with sedation.
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I’ve had a few minor surgeries as well as a lung biopsy since diagnosis. I think the most important issue is to let both the surgeon & the anesthesiologist know about your IPF so that they can be extra cautious about monitoring your oxygen levels during surgery. I haven’t had any complications.
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P.S. Due to my IPF, most surgeons have wanted to do the surgery in a hospital, rather than an outpatient clinic, in case there would be an issue with my breathing during surgery.
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