ative period and use
a limited dose post-
operatively for pain
control.
The type of opioid
you administer to
OSA patients matters
as well. Mr. Schmidt
prefers remifentanil
(Ultiva), which is
metabolized quickly
by esterases in the
blood and tissues,
instead of fentanyl,
morphine or hydromorphone, which are metabolized much slower
and can accumulate in adipose tissue, he says, adding that patients
with OSA tend to require less narcotic compared with the general
population.
4. Use the right anesthetic agent.
Though the guidelines don't strongly recommend one agent over
another, they do discuss a few options, including:
• Benzodiazepine. Despite limited data on the comparative effec-
tiveness of intravenous benzodiazepine sedation among patients with
and without OSA, benzodiazepines are known to induce upper airway
collapse for diagnostic purposes of OSA, the guideline states.
Therefore, using IV benzodiazepine may be associated with airway
compromise in OSA patients and should be avoided.
• Alpha-2 receptor agonists. Limited research shows that alpha 2
agonists might have less of an impact on breathing than other agents.
4 2 • 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
• WHILE YOU WERE SLEEPING Does your staff know the risks of operating on a
patient with undiagnosed and untreated obstructive sleep apnea?
