Postoperative Complications in Patients With Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Noncardiac Surgery

Kaw, Roop; Bhateja, Priyanka; Mar, Hugo Pazy; Hernandez, Adrián V.; Ramaswamy, Anuradha; Deshpande, Abhishek; Aboussouan, Loutfi S.

doi:10.1378/chest.14-3216

Cited by 87 publications

(61 citation statements)

References 25 publications

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“…63 Additionally, the prevalence of obesityhypoventilation syndrome has also been found to increase with increasing BMI, with one study finding a prevalence of OHS as high as 30.4% in subjects with a BMI Ն 40 kg/m 2 . 64 It was recently shown by Kaw et al 65 that subjects with either obesity-hypoventilation syndrome alone or obesity-hypoventilation syndrome plus OSA are more likely to develop postoperative respiratory failure, postoperative heart failure, and prolonged intubation time compared with patients with OSA alone. As a result, it is imperative that after extubation obese patients be immediately transitioned to the NIV strategy used to treat their underlying OSA/obesity-hypoventilation syndrome.…”

Section: Respiratory Care In the Postanesthesia Care Unit And Postextmentioning

confidence: 99%

Respiratory Management of Perioperative Obese Patients

et al. 2016

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SummaryWith a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia.

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Section: Respiratory Care In the Postanesthesia Care Unit And Postextmentioning

confidence: 99%

Respiratory Management of Perioperative Obese Patients

et al. 2016

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“…100 Therapeutic interventions for OHS therapy include CPAP therapy, bilevel positive airway pressure therapy, supplemental oxygen and weight reduction surgery. 101 …”

Section: Other Sleep-disordered Breathing Similar To Osamentioning

confidence: 99%

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

Subramani¹,

Singh²,

Wong

et al. 2017

Anesthesia &Amp; Analgesia

117

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Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing with potential long-term major neurocognitive and cardiovascular sequelae. The pathophysiology of OSA varies between individuals and is composed of different underlying mechanisms. Several components including the upper airway anatomy, effectiveness of the upper airway dilator muscles such as the genioglossus, arousal threshold of the individual, and inherent stability of the respiratory control system determine the pathogenesis of OSA. Their recognition may have implications for the perioperative health care team. For example, OSA patients with a high arousal threshold are likely to be sensitive to sedatives and narcotics with a higher risk of respiratory arrest in the perioperative period. Supplemental oxygen therapy can help to stabilize breathing in OSA patients with inherent respiratory instability. Avoidance of supine position can minimize airway obstruction in patients with a predisposition to upper airway collapse in this posture. In this review, the clinically relevant endotypes and phenotypes of OSA are described. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for most patients with OSA but tolerance and adherence can be a problem. Patient-centered individualized approaches to OSA management will be the focus of future research into developing potential treatment options that will help decrease the disease burden and improve treatment effectiveness.

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“…[55][56][57][58][59] Although the evidence on perioperative complications is limited, non-cardiac surgical patients with unrecognized OHS in a recent study were found to be at significantly higher risk of respiratory failure (odds ratio [OR], 10.9), heart failure (OR, 5.4), prolonged intubation (OR, 3.1), intensive care unit admission (OR, 10.9), and longer hospital stay when compared to OSA patients without hypoventilation. 60 The 61 Predictors of daytime hypercapnia in obese patients with OSA have included body mass index [ 39 kgÁm -2 , severe OSA with AHI [ 64 eventsÁhr -1 , and restrictive chest wall mechanics. 57 Preoperative screening for hypercapnia should be performed in patients deemed to be at high risk.…”

Section: Hypoventilationmentioning

confidence: 99%

Interpretation of sleep studies for patients with sleep-disordered breathing: What the anesthesiologist needs to know

Meliana

Chung

et al. 2017

Can J Anesth/J Can Anesth

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There is increased interest in the perioperative management of patients with sleep-disordered breathing (SDB). Anesthesiologists must distill information from clinical reports to make key decisions for optimizing perioperative care. A patient with SDB may present with a sleep study report at the time of surgery. Knowledge of the essential components of such a report can help the anesthesiologist evaluate the patient and optimize the perioperative management. In this narrative review, we describe how level I (i.e., laboratory-based) polysomnography (PSG) data are collected and scored using the recommended scoring guidelines, as well as the basic information and salient features of a typical PSG report relevant to the anesthesiologist. In addition, we briefly review the indications for sleep studies, including the types of laboratory-based studies, as well as the role and limitations of portable monitors (level II-IV studies) and examples of PSG reports in the clinical context.

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Postoperative Complications in Patients With Unrecognized Obesity Hypoventilation Syndrome Undergoing Elective Noncardiac Surgery

Abstract: Background: Among patients with obstructive sleep apnea (OSA) a higher number of medical

Cited by 87 publications

References 25 publications

Respiratory Management of Perioperative Obese Patients

Respiratory Management of Perioperative Obese Patients

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

Interpretation of sleep studies for patients with sleep-disordered breathing: What the anesthesiologist needs to know

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