This is an excerpt from an article by Dr. Richard L. Bruno. Dr. Bruno put
this article on the Internet and asked that it be shared with polio
survivors.
If you have to go under the knife, we suggest that you give a copy of this
article to each member of the surgical team and to the nurses on the
hospital floor where you will be staying. Discuss the article with your
doctor and ask that a copy be put in your medical chart.
PRE-OPERATIVE PREPARATION - This is the most important period, since this is
the period when you must establish communication with the surgical team.
After a second opinion, meet with the surgeon and the anesthesiologist to
discuss in detail your complete polio and general medical histories and any
problems that might arise before and during surgery, in the recovery room
and on the nursing floor.
LUNGS - It is recommended that all polio survivors have pulmonary function
studies as part of your preoperative testing. This will help the surgical
team evaluate the proper type of anesthesia for you and will help eliminate
any unpleasant surprises coming off a respirator at the end of surgery.
PHYSICAL ASSISTANCE - X-ray and examining tables are built at heights that
are convenient for the professional, not the patient. Many polio survivors
cannot step on a stool to get on a high table. Polio survivors must ask for
help in transferring. Since most polio survivors are not good at asking for
help, they need to find a phrase with which they are comfortable that will
communicate their needs. If you run into someone that does not want to help
or work with you, ask for someone else to help or ask to speak to their
supervisor
GENERAL ANESTHETICS - Polio survivors are exquisitely sensitive to
anesthetic. A little anesthetic goes a long way and lasts a long time due to
the damage of the brain stem - called the reticular activating system. Polio
survivors have been known to sleep for days after surgery.
For polio survivors we use the RULES OF 2 for surgery.
ANESTHETIC RULE OF 2 Polio survivors need the typical dose of anesthetic
divided by 2. This is merely to remind anesthesiologists that polio
survivors need much less anesthetic than do other patients. Also, polio
survivors can be sensitive to atropine-like drugs used during surgery.
POSITIONING - One overlooked problem is the positioning of the post-polio
patient on the operating table. Muscle atrophy, scoliosis and spinal fusion
may make certain positions problematic. It would be advisable for the
patient to be awake during positioning on the table to prevent post-op
complications..
POST-OPERATIVE CARE:
COLD - Polio survivors are extremely sensitive to cold because they have
difficulty regulating their body temperature.
No polio survivor should have same-day surgery for any reason
except for the most simple procedure that requires a local anesthetic.
POST-ANESTHETIC RULE OF 2 - Polio survivors require 2 times as long to
recover from the effects of any anesthetics.
BLOOD AND GUTS - Polio survivors with muscle atrophy will have a smaller
blood volume that would be expected for their weight and height. Therefore
bleeding during surgery may be more of a problem. Polio survivors cannot
control the size of their blood vessels, since the nerves that make the
smooth muscle around veins and capillaries contract were paralyzed by
poliovirus. Therefore, polio survivors blood vessels open under anesthetic
and dump the heat of their warm blood into the cold recovery room. Polio
survivors must be kept warm.
VOMITING - Another post-op problem related to brain stem damage is vomiting.
Polio survivors are more apt to faint (have vasovagal syncope and even brief
asystoles) when they attempt to vomit. It is important that post-op emetic
control be discussed with the anesthesiologist and administered before going
to the recovery room.
CHOKING - Polio survivors who are aware of having swallowing problems, and
sometimes in those without apparent swallowing difficulty, cannot clear
secretions and may choke when they are lying on their backs. Polio survivors
secretions need to be monitored in the recovery room and they should be
positioned on their side if possible so that secretions can drain.
PAIN - The
single most troublesome problem after surgery is pain control.
Under-medication is a serious problem for the post-polio patient since two
research studies have shown that polio survivors are twice as sensitive to
pain as those who didn't have polio.
RULE OF 2 FOR PAIN Polio survivors need 2 times the dose of pain medication
for 2 times as long.
RECOVERY - Polio survivors need more bed rest than most patients, because of
autonomic nervous system damage. Polio survivors are the best judges of when
they can move, stand and walk safely.
RULE OF 2 FOR RECOVERY - Polio survivors should stay in bed 2 times longer
than other patients.
RULE OF 2 FOR LENGTH OF STAY - Polio survivors need to stay in the hospital
2 times longer than other patients.
RULE OF 2 FOR WORK - Polio survivors need 2 times the number of days of rest
at home before they return to work or household duties.
RULE OF 2 FOR FEELING BETTER - Polio survivors need 2 times longer to feel
back to normal again.
CONCLUSION
All of the Rules of 2 are suggestions for polio survivors and the surgical
team; they are not a substitute for specific information about the
individual patient and communication among all members of the treatment
team, including the patient.
