expense and length of
time to receive
results, the guidelines
suggest using the
STOP-Bang question-
naire (see "Can We
Identify Patients
With Sleep Apnea?"
on page 24). STOP-
Bang asks patients to
self-report things like
snoring, apneic
episodes and daytime
somnolence, as well
as physical character-
istics such as BMI and
neck circumference,
gender, age and airway anomalies.
Because there is "no single reliable predictor of difficult airway,"
you also should take into account other "routinely used indicators of
potential difficult airway, which include Mallampati score, limited
neck movement and limited thyromental distance," says Girish P.
Joshi, MBBS, MD, FFARCSI, a professor of anesthesiology and pain
management at the University of Texas Southwestern Medical Center
in Dallas and co-author of the guidelines.
Though this is a crucial step in caring for patients at risk of OSA,
many facilities simply don't take the time to perform the question-
naire, says Dr. Memtsoudis. "The first step should always be a rigor-
ous way of IDing patients with sleep apnea, and then you can deter-
mine how to handle those patients who are identified," he says. "Is it
3 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
If sleep apnea is trying to breathe
through a straw, then residual
neuromuscular blockade is
someone sitting on your chest
while you breathe through a straw.
