• Curr Opin Anaesthesiol · Dec 2018

    Review

    Best perioperative practice in management of ambulatory patients with obstructive sleep apnea.

    Obstructive sleep apnoea patients receiving opioids should have post-operative continuous monitoring.

    pearl
    • Mahesh Nagappa, Yamini Subramani, and Frances Chung.
    • Department of Anesthesiology and Perioperative Medicine, University Hospital, Victoria Hospital and St. Joseph's Hospital, London Health Sciences and St. Joseph's Healthcare, Western University, London.
    • Curr Opin Anaesthesiol. 2018 Dec 1; 31 (6): 700-706.

    Purpose Of ReviewThe perioperative outcome in obstructive sleep apnea (OSA) patients undergoing ambulatory surgery can be potentially impacted by the type of anesthetic technique, fluid management and choice of anesthetic agents. This review highlights the best perioperative practices in the management of OSA patients undergoing ambulatory surgical procedures.Recent FindingsA recent meta-analysis found that STOP-Bang might be used as a perioperative risk stratification tool. Patients with high-risk OSA (STOP-Bang ≥3) were found to be associated with an increased risk of postoperative complications and prolonged length of hospital stay compared with low-risk OSA (STOP-Bang 0-2) patients undergoing noncardiac surgical procedures. A bidirectional relationship exists between OSA and difficult airway. Both suspected or diagnosed OSA may be associated with either difficult intubation or difficult mask ventilation or both. A recent meta-analysis identified OSA as an important risk factor for opioid-induced respiratory depression. A dose-response relationship was shown between the morphine equivalent daily dose and death or near-death events in OSA patients undergoing surgery. Postoperative continuous monitoring is recommended for high-risk OSA patients receiving opioids. Minimising the dose of muscle relaxant, neuromuscular monitoring and ensuring complete reversal of neuromuscular blockade before extubation is essential in OSA patients to avoid postoperative complications. Whenever feasible, regional anesthesia with multimodal analgesia may be considered as a better alternative to general anesthesia in OSA patients.SummaryPatients with OSA and associated comorbidities present a challenge to anesthesiologists as they are at a high risk of perioperative complications. It is important to identify patients with OSA, with the goal to raise awareness among providers, mitigate risk and improve outcomes.

      Pubmed     Full text  

      Add institutional full text...

    Notes

    pearl
    1

    Obstructive sleep apnoea patients receiving opioids should have post-operative continuous monitoring.

    Daniel Jolley  Daniel Jolley
    pearl
    0

    High STOP-Bang score ≥ 3 continues to be a useful predictor of post-operative complications and length of hospital stay.

    Daniel Jolley  Daniel Jolley
     
    Do you have a pearl, summary or comment to save or share?
    250 characters remaining
    help        
    You can also include formatting and links in your notes
    • Simple formatting can be added to notes, such as _italic_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)

    hide…

Want more great medical articles?

Keep up to date with a free trial of metajournal, personalized for your practice.
845,020 articles already indexed!

We guarantee your privacy. Your email address will not be shared.