How long to wait to have surgery AFTER diving?

[potato cod]

I should probably contact DAN about this one, but does anyone know if there are guidelines for how long to wait to schedule surgery AFTER a dive trip? This would involve general anesthesia and the dive trip will be ~17 dives over a week (3 dives/day). I would assume it would be important to make sure all nitrogen was completely out of the system, etc., but not sure.

I've got a narrow window between the dive trip and some work stuff when I'd ideally get things scheduled.

 

[ps444mike]

I would contact DAN an talk with your Surgeon.. I lucked out on my surgery as my Dr was also a diver..

 

[Doctorfish]

Never mind your surgeon. He/she unlikely to know. Your anesthesiologist might have an answer. I'm a surgeon and if was posed that question, I would call DAN or one of the hyperbaric medicine experts in my institution.

 

[Duke Dive Medicine]

I should probably contact DAN about this one, but does anyone know if there are guidelines for how long to wait to schedule surgery AFTER a dive trip? This would involve general anesthesia and the dive trip will be ~17 dives over a week (3 dives/day). I would assume it would be important to make sure all nitrogen was completely out of the system, etc., but not sure.

I've got a narrow window between the dive trip and some work stuff when I'd ideally get things scheduled.

That's an interesting question. The US Navy Required Surface Interval Before Ascent to Altitude After Diving table (Navy Diving Manual Revision 7, page 9-62) recommends waiting 48 hours after an exceptional exposure dive (long, deep dives that are specifically denoted in the dive tables) prior to ascending to any altitude. Ascent to altitude isn't the same as surgery, but I think it's safe to assume that any residual nitrogen in your system will be gone by 48 hours out, even if you were diving aggressively. Out of an abundance of caution, I might consider diving conservatively over your last couple of days of diving.

A theoretical point, more a thought exercise than anything really, would be that aggressive diving could result in mild generalized inflammation even in the absence of clinical DCS. As to whether that could influence surgical outcomes, I don't think there's any literature on that.

I pinged one of our attending physicians who's also an anesthesiologist for his opinion. Will post what I hear.

Best regards,
DDM

 

[Duke Dive Medicine]

Update: Nitrous oxide administration could precipitate bubble formation in divers with residual dissolved nitrogen; I think that's been mentioned on SB before. Aside from that, there are no interactions with anesthesia agents.

Best regards,
DDM

 

[potato cod]

Thanks! I've got another consult in a few days, but the surgeon I met with this morning does surgery three days a week, so we should be able to schedule something that is at least 3-4 days after diving and still allow for adequate recovery before work obligations. I'm a pretty conservative diver in any event, but will take it especially easy at the end of the trip.

 

[doctormike]

Nitrous oxide does diffuse into closed spaces and expand during anesthesia, that's why we don't use it when doing a tympanic membrane repair (can theoretically displace the graft). I suppose that if you had circulating bubbles, it might diffuse into them too?

But given the length of time just the preop paperwork takes on the morning of surgery, I would think that you would be pretty much outgassed by the time of induction!

Paging Dr. @rsingler for an opinion...

 

[rsingler]

With a long series of dives, even after 48 hours, there could be residual nitrogen in your slowest compartment that, if in microbubble form, could grow upon exposure to N2O, as noted above by @Duke Dive Medicine .
If you have a tight window for surgery (e.g. within 72 hours after your last dive), simply ask your anesthesiologist to omit nitrous oxide. In fact, I rarely still use it today. If your anesthesiologist balks at this request, find another anesthesiologist. It's not an unreasonable request, whether or not he/she understands diving physiology.

I picked 72 hours as more than 5 half lives for both a 300 minute compartment and an imaginary 635 minute Buhlman compartment.

"Diving" Anesthesiologist
Former Hyperbaric Doc

 

[potato cod]

Thanks, all. Surgery ended up getting scheduled a full week after my last dive, so should be no problem. I'll still ask the anesthesiologist about omitting nitrous oxide when I have a consult with her.