Perioperative considerations for adult patients with obstructive sleep apnea

Abstract

Purpose of reviewObstructive sleep apnea (OSA) is a common, but often undiagnosed, sleep breathing disorder affecting approximately a third of adult surgical patients. OSA patients have increased sensitivity to anesthetic agents, sedatives, and opioid analgesics.Recent findingsNewer technologies (e.g., bedside capnography) have demonstrated that OSA patients have repetitive apneic spells, beginning in the immediate postoperative period and peaking in frequency during the first postoperative night. Compared to patients without OSA, OSA patients have double the risk for postoperative pulmonary as well as other complications, and OSA has been linked to critical postoperative respiratory events leading to anoxic brain injury or death. Patients with OSA who have respiratory depression during anesthesia recovery have been found to be high-risk for subsequent pulmonary complications. Gabapentinoids have been linked to respiratory depression in these patients.SummarySurgical patients should be screened for OSA and patients with OSA should continue using positive airway pressure devices postoperatively. Use of shorter acting and less sedating agents and opioid sparing anesthetic techniques should be encouraged. In particular, OSA patients exhibiting signs of respiratory depression in postanesthesia recovery unit should receive enhancer respiratory monitoring following discharge to wards.

Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions

“…PAP utilisation is associated with a 28% risk reduction in pulmonary complications and reduces unplanned ICU admissions by 56% [16 ▪▪ ]. This highlights the importance of perioperative optimisation of PAP and illustrates how patients’ receiving PAP therapy in postoperative period is paramount [42].…”

“…]. This highlights the importance of perioperative optimisation of PAP and illustrates how patients' receiving PAP therapy in postoperative period is paramount [42].…”

“…Patients should be closely monitored, it is reasonable that patients undergo an extended recovery or are cared for either in the postanesthesia care unit (PACU) or high dependency unit (HDU) setting [42]. Bedside capnography has been demonstrated as a useful tool in predicting postoperative respiratory events [22,42] and may be considered in these patients.…”

“…Postoperative disposition of patients with OSA is a key consideration given the increased risk of complications, particularly postoperative pulmonary complications [14 ▪▪ ]. Patients should be closely monitored, it is reasonable that patients undergo an extended recovery or are cared for either in the postanesthesia care unit (PACU) or high dependency unit (HDU) setting [42]. Bedside capnography has been demonstrated as a useful tool in predicting postoperative respiratory events [22,42] and may be considered in these patients.…”

Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study

“…Yet, despite these guidelines, reported incidences of severe postoperative respiratory depression events remain mostly unchanged. 6 Opioid-sparing anesthetic techniques have been developed also to mitigate the risk of postoperative respiratory depression 7 ; however, evidence has been inconclusive about whether they achieve this aim. 8 Paradoxically, some components of opioid-sparing techniques, such as use of gabapentin, may increase risk of this specific complication.…”