Faculty Collaboration Database

Anesthetic management of obstructive sleep apnea patients. J Clin Anesth 1991;3(6):461-9

Date

11/01/1991

Pubmed ID

1760169

DOI

10.1016/0952-8180(91)90094-4

Scopus ID

2-s2.0-0025837225 (requires institutional sign-in at Scopus site)   92 Citations

Abstract

Presented in an illustrative case report and a review of the anesthetic management of obstructive sleep apnea patients. Preoperative evaluation should include a thorough airway evaluation and a comprehensive cardiovascular and pulmonary evaluation. With polysomnography, identification of the severity of sleep apnea can be idenified. Although sleep centers vary in their definitions, severe obstructive sleep apnea is diagnosed if the patient demonstrates an apnea index greater than 70 and an oxygen (O2) desaturation less than 80% with cardiovascular sequelae. Severe sleep apnea patients are at extreme risk for general anesthesia. These risks should be discussed preoperatively with the patient. Unsupervised preoperative sedation should be avoided because of the extreme sensitivity of these patients to sedatives and airway obstruction. Intraoperative management of the obstructive sleep apnea patient varies depending on the severity of the sleep apnea. Invasive monitoring may be necessary if the patient demonstrates evidence of cardiopulmonary dysfunction. With the assistance of the otolaryngologist, the anesthesiologist can formulate an approach to establishing an airway. Intraoperative opioids and sedatives should be limited. The recovery of the sleep apnea patient is extremely important and is the time when most airway emergencies occur. Extubation of the patient should occur when appropriate surgical personnel and equipment are available in case of an airway emergency. Steroids may be used to decrease the amount of airway swelling. Supplemental O2 should be used in patients who demonstrate desaturation. Opioids and sedatives should be avoided, as should other drugs that have central and sedating effects. Postoperative pain is effectively controlled with acetaminophen and topical anesthetic sprays. Postoperative monitoring for apnea, desaturation, and dysrhythmias is a necessity in sleep apnea patients.

Author List

Connolly LA

Author

Lois A. Connolly MD Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Anesthesia, Inhalation
Anesthesia, Intravenous
Fentanyl
Humans
Isoflurane
Male
Nitrous Oxide
Preanesthetic Medication
Sleep Apnea Syndromes
Thiopental