Ask a doctor on the topic of Anesthesiology

Admission to the IMC or ICU after surgery.

January 9, 2013 | 20,00 EUR | answered by Dr. med. Kathrin Hamann

Dear Sir or Madam,

I have a question regarding the intensive care unit. I will soon undergo surgery (general and visceral surgery) and a surgical excision in toto of pronounced lipomatosis of the thorax and arm area will be performed. About 15-20 lipomas in different areas of the chest (left ventral), flank, and left arm will be removed. The estimated duration of the surgery is 1.5 hours. During my first surgery session in October 2012 (lipoma excision from the abdominal and back area), a time of about 1.5 hours was also estimated, but in reality, it extended to 3 hours.

I personally (likely also due to family history) have a strong tendency to respond poorly and resist pain medication. This could be partly due to my daily medication of 50mg of Citalopram. In past procedures, I have always had a very high need for pain medication. Two surgeries that were initially planned as outpatient procedures (knee arthroscopy, epicondylitis) had to be changed to inpatient postoperatively due to severe pain.

Now to the actual question: My grandfather also had a pronounced lipomatosis with multiple surgeries. He also had almost identical surgery on the chest, flank, and arm. Postoperatively, he had very severe pain (which is likely also why I respond poorly to pain medication) and was eventually transferred from the regular ward to the ICU or IMC unit (for the first night). Since I am facing the same surgery now, I am wondering if I can arrange with the anesthetist to be admitted to the ICU or at least the IMC unit for the first night? I am aware that strong anesthesia can lead to hypoventilation/respiratory depression, which worries me, and I would feel much more comfortable if the first night after surgery were under close observation.

Based on this medical history, is a short stay in the IMC justified, or is there a possibility that the attending physician will accommodate, or is an ICU/IMC stay generally not indicated for this type of surgery?

I would greatly appreciate a brief response!

A little about myself: male, 27 years old, slightly overweight (180cm - 99kg), non-smoker, Mallampati I, ASA I-II, no pre-existing conditions, sleep disorders, daily medication of 40-50mg of Citalopram.

Thank you!

Kind regards

Dr. med. Kathrin Hamann

Hello,

Thank you for your inquiry, which I would like to answer as follows.
You can definitely arrange to come directly to the ICU with the responsible anesthetists immediately after the surgery. In any case, you will be closely monitored for at least 2 hours after the surgery (similar to an ICU) in the recovery room (IMC).
Make sure to also discuss your tendency towards pain medication resistance.
The respiratory depression you are concerned about actually only occurs with opioids, which are often used as analgesics. However, since you will be closely monitored in the recovery room after the surgery, this risk is balanced with controlled safety. So you don't need to worry.

Do you have any questions about this? I am happy to help.

All the best and a speedy recovery!
Best regards,

Dr. K. Hamann