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

Abstract

The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.

<p>Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery</p>

“…To avoid serious OSA-related complications, postoperative analgesia should be given to patients on the recommendations of guidelines and literatures, as well as the clinical experience of local medical institutions. 46,47 Our study has several limitations. Firstly, this was a retrospective study and there could be inevitable data loss.…”

Tracheal Ultrasound for the Accurate Confirmation of the Endotracheal Tube Position in Obese Patients

“…This finding may be related to the anatomic changes in the upper airway of patients with obesity. These changes include oropharyngeal crowding, narrowing of the upper airway, macroglossia, retrognathia, a thick neck, a reduced mandibular length, an inferiorly positioned hyoid bone, and a retroposition of the maxilla . In addition, endotracheal intubation was performed with a direct laryngoscope in our study, which may have increased the risk of esophageal intubation.…”

Randomized, double-blind, placebo-controlled study of the analgesic effect of intraoperative esmolol for laparoscopic gastroplasty

“…No preanesthetic medication was given because benzodiazepines, especially midazolam, are related to the increasing respiratory complications in obese patients. 16 Anesthesia was maintained with sevoflurane, which is rapidly eliminated from obese patients, with faster return of activities, less obstructive sleep apnea, and a low incidence of nausea and vomiting.…”