Perioperative incidence of airway obstructive and hypoxemic events in patients with confirmed or suspected sleep apnea - a prospective, randomized pilot study comparing propofol/remifentanil and sevoflurane/remifentanil anesthesia

Abstract

BackgroundObstructive sleep apnea (OSA) is a risk factor for perioperative complications but data on anesthesia regimen are scarce.MethodsIn patients with established or strongly suspected OSA, we assessed in a prospective, randomized design the effects on nocturnal apnea-hypopnea-index (AHI) and oxygen saturation (SpO2) of propofol/remifentanil or sevoflurane/remifentanil based anesthesia. Patients were selected by a history for OSA and / or a positive STOP – questionnaire and received general anesthesia using remifentanil (12 μg/kg/h) combined either with propofol (4-6 mg/kg/h, n = 27) or sevoflurane (approx. 2.2 vol% endtidal, n = 27). AHI and SpO2 were measured during the nights before and after anesthesia.ResultsThere were no differences in AHI between anesthetic regimens nor between the pre- and postoperative nights (propofol: 8.6 h− 1 (median, CI: 3.6–21.9) vs. 7.9 h− 1 (1.8–28.8); p = 0.97; sevoflurane: 3.8 h− 1 (1.8–7.3) vs. 2.9 h− 1 (1.2–9.5); p = 0.85). Postoperative minimum SpO2 (propofol: 80.7% ± 4.6, sevoflurane: 81.6 ± 4.6) did not differ from their respective preoperative baselines (propofol: 79.6% ± 6.5; p = 0.26, sevoflurane: 80.8% ± 5.2; p = 0.39). Even in patients with a preanesthetic AHI > 15, nocturnal AHI remained unchanged postoperatively.ConclusionThus, in a cohort of patients with suspected or confirmed OSA undergoing surgery of moderate duration and severity neither the volatile agent sevoflurane nor the intravenous anesthetic propofol altered nocturnal AHI or oxygen saturation, when combined with the short acting opioid remifentanil.Trial registrationGerman Clinical Trials Register, DRKS00005824 retrospectively registered on 03/12/2014.

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

“… 154 , 155 However, sevoflurane was found to be superior to propofol in 2 RCTs due to faster anesthesia recovery and improved hemodynamic stability. 152 , 153 In addition, recently Fassbender et al 151 reported no difference with regard to postoperative obstructive and hypoxemic events between the 2 anesthetic agents when combined with remifentanil. Furthermore, comparing propofol and desflurane, 1 study demonstrated that the use of propofol impaired pulmonary function and SpO 2 to a greater degree than desflurane, 157 while another could not confirm these differences.…”

“…In this context, 25 studies were identified that compared the efficacy and recovery profile among the most common inhalational agents and intravenous propofol. 65 , 151 – 174 A summary of evidence is provided in Supplemental Digital Content, Tables A7 and A8, http://links.lww.com/AA/C373 . Comparing propofol and isoflurane, propofol was suggested to be associated with a faster recovery from anesthesia and improved postoperative respiratory control in 2 RCTs.…”

“…Given the strong association between obesity and OSA, and the benefits of accelerating and improving postoperative anesthesia recovery, these outcomes are desirable and may apply to patients with OSA as well. However, except for 2 RCTs, 151 , 154 no studies specifically in OSA are available, and thus no specific recommendations can be made.…”

The correlation of upper airway abnormalities with obstructive sleep apnea syndrome in young adult

“…4,5 The prevalence of OSAS in the general population, around 11.4% for men and 4.7% for women and is expected to increase every year. 6 OSAS screening can be done using the Berlin questionnaire and the Epworth Sleepness Scale (ESS) questionnaire. 7 But, the gold standard for diagnosis of OSAS can definitely use polysomnography (PSG).…”

“…[9][10][11] Apart from all clinical and scientific advances regarding OSAS, most (70-90%) people affected by OSAS remain undiagnosed. 6 Lack of patient awareness, medical personnel have not received the training needed to help speed up case finding, and the high price of PSG examinations as gold OSAS standards are the cause of many undiagnosed OSAS patients. Therefore, knowledge of risk factors for OSAS is important to direct diagnostic attention to those with the highest risk.…”