AANA journal
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Hip fractures occur commonly in elderly patients. Many of these patients have multiple comorbidities requiring the use of anticoagulants. ⋯ This case report discusses the advantages and pitfalls of the selection of local anesthetic and monitored anesthesia care using a propofol-ketamine-lidocaine admixture for an elderly patient with a femoral neck fracture who was receiving dabigatran etexilate (Pradaxa). This case illustrates the potential for sedation during monitored anesthesia care to progress to general anesthesia and its associated risks as well as special considerations for anesthesia in geriatric patients.
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Obstructive sleep apnea (OSA) affects approximately 20% of Americans. Patients with undiagnosed OSA may experience obstructive episodes during conscious sedation for colonoscopy. The purpose of this investigation was to describe the risk of undiagnosed OSA using the Berlin Questionnaire and to identify the relationship between OSA risk and the number of provider interventions performed to relieve obstructive symptoms during sedation for colonoscopy. ⋯ The incidence of undiagnosed OSA was 40.4%. Patients with hypertension had a higher rate of a positive screen for OSA (70%) than those without hypertension (20.3%), chi2(1) = 3.87, P < .05. There was no statistical difference in the number of provider interventions between the 2 groups. Risk of undiagnosed OSA in this sample is large but it does not appear to be associated with episodes of obstructive symptoms requiring provider intervention.