Postoperative apnea, respiratory strategies, and pathogenesis mechanisms: a review

Abstract

Recovery from anesthesia is ideally routine and uneventful. After extubation, the recovering postoperative patient ought to breathe without supportive care or additional oxygenation. It has been demonstrated in previous studies that postoperative pulmonary complications are clinically relevant in terms of mortality, morbidity, and length of hospital stay. Compromised postoperative ventilation can be described as the condition in which the postoperative patient does not have satisfactory spontaneous ventilation support and adequate oxygenation. Causes of impaired ventilation, oxygenation, and airway maintenance can be mechanical, hemodynamic, and pharmacologic. This review describes prevalence and differential diagnosis, including co-morbidities of postoperative apnea. The physiological mechanisms of breathing and prolonged postoperative apnea are also reviewed; these mechanisms include influences from the brainstem, the cerebral cortex, and chemoreceptors in the carotid and aortic body. Causes of prolonged postoperative apnea and management are also discussed.

Pilot Findings of Pharmacogenomics in Perioperative Care: Initial Results From the First Phase of the ImPreSS Trial

“…1 During anesthesia and postoperative care, particularly high-risk adverse drug outcomes include malignant hyperthermia, prolonged apnea, sedation, and inadequate pain management. [2][3][4] Pharmacogenomics is the study of how germ line polymorphisms affect a person's response to medications and is being increasingly recognized as a potentially important factor to guide medication prescribing and decrease adverse drug reactions. [5][6][7][8][9][10] However, there are barriers to pharmacogenomic application in clinical practice, such as availability of routine genetic tests, difficulty translating results into actionable prescribing information, lack of provider knowledge, and integration into the clinical workflow.…”