But because the evidence is so limited, the guideline stops short of
recommending these agents for use of sedation in patients with OSA,
says Dr. Memtsoudis.
• Propofol. The use of propofol sedation in OSA patients requires a
heightened level of vigilance as well as careful monitoring and titra-
tion, SASM stresses. Research suggests that patients with OSA who
receive propofol for sedation could be at increased risk for respirato-
ry compromise and hypoxemic events. Instead of a specific agent, our
experts suggest finding a shorter-acting anesthetic that has limited
impact on the patient's breathing and is metabolized quickly. You also
want to aim to use a minimal number of drugs in patients, especially
those at risk of OSA, due to potential drug-to-drug interactions, adds
Dr. Joshi.
5. When possible, use regional anesthesia.
An even better option is to use regional anesthesia, the guideline sug-
gests. Not only will this reduce the impact on the patient's airway, but
by not using general anesthesia you can avoid issues caused by resid-
ual NMBA, provide effective pain management, reduce opioid con-
sumption and reduce the overall stress on the body. Despite the many
benefits, some wonder why blocks aren't more popular.
"Knee and hip arthroplasties are known to be especially amendable
to the use of regional anesthesia, because you can use a neuraxial
anesthetic to provide surgical anesthesia below the waist and avoid
intubating the patient," says Dr. Memtsoudis. "But only a minority of
patients — 1 in 4 — receive a regional anesthetic for this procedure in
the U.S. We know using regional over general anesthesia makes a big
difference in terms of reducing the risk of complications. But its lack
of use suggests to me that not all providers are aware of the magni-
tude of its benefits."
OSM
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