Perioperative care of obstructive sleep apnea patients: A survey of European anesthesiologists

Abstract

Background: Obstructive sleep apnea (OSA) is prevalent in the surgical patient population and is associated with high risk of perioperative complications. There are limited guidelines and wide practice variations regarding the perioperative care of obese and OSA patients. This is a study of European anesthesiologists' clinical practice of perioperative care of OSA patients. Methods: This survey evaluated United Kingdom anesthesiologists' clinical practice of the perioperative care of OSA patients. Outcomes and variables were compared between 4100 anesthesiologists of different clinical experience and hospital settings. Results: Approximately 45% of respondents manage OSA patients rarely, 42% occasionally, and 13% regularly. Most respondents order OSA screening tests if patients have tonsillar hypertrophy, head/neck tumor, BMI >35, increased neck circumference, craniofacial anomaly, and right-sided electrocardiography (ECG) anomaly. Majority request preoperative polysomnography, ECG, overnight pulse oximetry, and arterial blood gas analysis. Majority recommend preoperative weight loss, optimisation, smoking cessation, reduction of substance use, and regular mask-CPAP use. Majority consider endoscopy, and ophthalmology as appropriate day case procedures, but not laparoscopy. Majority postpone elective airway, laparoscopic, laparotomy, and head/neck surgery; if patients are not optimized preoperatively. For major surgery, combined general + neuraxial anesthesia was ranked as 3 rd option. For major limb surgery, neuraxial anesthesia without sedation was ranked as 1 st option, nerve block without sedation was ranked 2 nd , and general anesthesia + nerve block was ranked 3 rd or 4 th . At anesthesia emergence, majority ensure that patients have normal consciousness, respiration and neuromuscular function. Majority ensure postoperative oximetry, telemetry, and oxygen supplementation. Conclusion: This study highlights variations in anesthesiologists' perioperative care of OSA patients; even in developed countries with advanced medical training and standards. The study outcomes will improve perioperative care of OSA patients.

Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 2 Decision-Making in Surgical Management and Peri-Operative Considerations

“…There is a lack of evidence in the literature regarding the standard pre-operative workup for the management of OSA. A study by Bamgabde et al highlighted variations in anesthesiologists' peri-operative care of OSA patients, even in developed countries with advanced medical training and standards [33]. This is generally reflected in our study's failure to achieve a high level of consensus in all aspects of pre-operative workup.…”

Preoperative Assessment of Patients with Obstructive Sleep Apnea - Implications for Anesthesiologists

“…OSA screening tests were ordered if the patients had tonsillar hypertrophy, head/neck tumor, BMI >35, increased neck circumference, craniofacial anomaly, and a right sided electrocardiography anomaly. Most of the anesthesiologists indeed encouraged a different anesthesia strategy for those patients, such as administering neuraxial anesthesia without sedation or ensuring patients' being awake, a semi sitting and normal breathing before extubation [10].…”

“…Drugs commonly used during general anesthesia (such as hypnotics, opioids and muscle relaxants) have been shown to reduce the tone of the upper-airway dilating muscles, the protective airway reflexes and the central respiratory drive, thereby inducing hypoxia and arousal [9]. Thus, patients with OSA who are about to undergo a surgical procedure requiring general anesthesia present significant challenges to anesthesiologists necessitating a special anesthesia strategy [10]. Implementation of specific perioperative actions could prevent critical, life-threatening conditions during surgery as well as serious postoperative events.…”