O C T O B E R 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 4 1
The study's authors note that the STOP-Bang questionnaire was
originally designed to rule out OSA in a surgical patient population
in which STOP-Bang scores of greater than or equal to 3 indicated
a higher risk of OSA, however, this can lead to false positives.
Instead, they found that nearly 91% of patients with a STOP-Bang
score of 6 or higher had an Apnea Hypopnea Index (AHI) score of
greater or equal to 15, which indicates moderate to severe OSA.
However, 95% of those who scored less than a 2 on the STOP-
Bang questionnaire did not have an AHI score of greater than 15
and were therefore less likely to have moderate to severe OSA.
"We suggest that the STOP-Bang questionnaire is used as a
first-line screening tool to exclude patients with low risk of sleep
apnea (a STOP-Bang score <2) and to identify patients with a high
risk of moderate and severe sleep apnea (a STOP-Bang score of
≥6)," the researchers write, adding, "We suggest the addition of
nightly pulse oximetry in patients with a STOP-Bang score of 2-5
when there is a need for screening for sleep apnea (before sur-
gery)." — Kendal Gapinski
and intra-operative lidocaine and magnesium drips have also been
shown to be effective for pain control. Additionally, though the guide-
line notes that specific evidence is lacking, there is emerging research
showing a potentially favorable impact of using ketamine as an
adjunct over other sedatives because it seems to preserve the
patient's upper airway and ventilatory function (see "8 Little-Known
Facts About Ketamine" at osmag.net/jY5gRR).
Nevertheless, it may not always be possible to avoid opioids, partic-
ularly after a major surgery, says Dr. Joshi. In these instances, he says
it may be best to completely avoid using opioids during the intraoper-
