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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
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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
