Outpatient Surgery Magazine

The Great Prepping Debate - December 2012 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 89 of 159

OSE_1212_part2_Layout 1 12/5/12 9:51 AM Page 90 C H A L L E N G I N G I N T U B A T I O N S PERIOPERATIVE MANAGEMENT 15 Challenges of Outpatient OSA Patients Intraoperative • Difficult/failed mask ventilation and/or tracheal intubation • Difficulty in ventilation and/or maintaining adequate oxygen saturation • Difficulty in positioning • Exacerbation of cardiac comorbidities: hypertension, arrhythmias, myocardial ischemia and infarction, pulmonary hypertension, heart failure Immediate post-operative • Delayed extubation • Obstruction and/or desaturation after extubation • Post-obstructive pulmonary edema • Need for tracheal reintubation • Exacerbation of cardiac comorbidities • Cerebrovascular disorders (stroke, for example) • Post-operative delirium • Prolonged PACU stay/delayed discharge home • Unanticipated hospital admission Post-discharge • Readmission after discharge • Hypoxic brain death and death 1. Pre-op screening Screen all patients for OSA using the STOP-BANG questionnaire (see page 44) and physical examination, as OSA is actually a relatively common sleep-related breathing disorder that often goes undiagnosed. Because OSA is associated with significant consequences such as daytime sleepiness, neurocognitive dysfunction, cardiovascular disorders (such as hypertension, ischemic heart disease, arrhythmia, pulmonary hypertension and congestive heart failure), metabolic dysfunction and impaired quality of life, it poses a real surgical risk.1–5 9 0 O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | D E C E M B E R 2012

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