Purpose Obstructive sleep apnea (OSA) is presumed to be a risk factor for postoperative morbidity and mortality, but the current evidence is incomplete. This retrospective matched cohort study tested the hypothesis that OSA is a risk factor for the development of postoperative complications. Methods Hospital ethics approval was obtained for the conduct of this study. The patients who were selected for the study were [18 yr of age, diagnosed preoperatively with OSA, and scheduled to undergo elective surgery. A cohort of surgical patients without OSA was used as a comparator group based on a one-to-one match. Matching criteria included gender, age difference \5 yr, type of surgery, and a \5 yr difference between two surgery dates. Summary data are presented and conditional logistic regression was used to identify risk factors for postoperative complications.Results The 240 pairs of study subjects aged 57 ± 13 yr included 184 (77%) males and 56 (23%) females. The OSA patients had a higher mean body mass index relative to their non-OSA counterparts (35 ± 9 vs 28 ± 6 kg Á m -2 , respectively) and a higher frequency of co-morbidities, including hypertension (48% vs 36%, respectively) and obesity (61% vs 23%, respectively). Also, the incidence of postoperative complications in the OSA patients was significantly greater (44% OSA group vs 28% non-OSA

Purpose Unintentional extubation of the trachea while the anesthetized patient is in the prone position is a potentially life-threatening situation that is usually managed by turning the patient supine for emergent re-intubation. However, this approach may delay definitive airway management and lead to irreversible complications. This review evaluates the efficacy of insertion of a laryngeal mask airway device (LMAD) with the patient in the prone position as a rescue method in airway management for unintentional tracheal extubation. Principal findings We searched MEDLINE and EMBASE databases in the English language for the period 1980 to October 2009 in order to identify observational studies and case reports describing insertion of the LMAD with the patient in the prone position. We found 12 such articles (n = 526 patients) consisting of four retrospective studies, one prospective cohort with a control group, one non-controlled prospective study, and six case reports. On the first attempt, the LMAD was inserted successfully in 87.5-100% of the patients involved in the included reports. On the second attempt, the LMAD was inserted successfully in all patients, with or without laryngoscopy. Ventilation was maintained successfully in the lungs of 83.3-100% of the patients involved in the reported articles. Following insertion of the LMAD with patients in the prone position, the most common complications reported were sore throat, bleeding, bradycardia, and laryngospasm.Conclusions Cumulative experience from published reports suggests the feasibility of placing the LMAD with the patient in the prone position in the elective setting; however, the evidence is lacking regarding the use of this method for emergency management of unintended tracheal extubation with the patient in the prone position. RésuméObjectif L'extubation involontaire de la trache´e alors que le patient est en procubitus est une situation potentiellement fatale qu'on corrige en ge´ne´ral en couchant le patient afin de re´aliser une re´intubation urgente. Cette approche pourrait cependant retarder la prise en charge des voies ae´riennes de´finitive et entraıˆner des complications irre´versibles. Cet article de synthe`se e´value l'efficacite´de l'insertion d'un masque larynge( LMAD) chez un patient en procubitus en tant que me´thode de sauvetage pour la prise en charge des voies ae´riennes lors d'une extubation trache´ale involontaire. Constatations principales Nous avons passe´en revue les bases de donne´es MEDLINE et EMBASE en anglais pour la pe´riode allant de 1980 a`octobre 2009 afin de retrouver les e´tudes observationnelles et les pre´sentations de cas de´crivant l'insertion d'un LMAD chez des patients en procubitus. Nous avons re´cupe´re´12 articles (n = 526 patients), soit quatre e´tudes re´trospectives, une e´tude prospective de cohorte avec groupe te´moin, une e´tude prospective sans groupe te´moin et six pre´sentations de cas. L'insertion du LMAD a re´ussi au premier essai dans 87,5-100 % des patients de´crits dans les pre´sentatio...