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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
What's more, the prevalence of OSA is increasing and is reported to
be higher in the surgical population than in the general population.6,7
As such, it's likely outpatient facilities and their anesthesia providers
will increasingly encounter patients with OSA — diagnosed or not —
in the ambulatory setting. So, in addition to screening using STOPBANG to determine suspected OSA, you should also assess the
patient's comorbid conditions, including hypertension, arrhythmias,
heart failure, cerebrovascular disease and metabolic syndrome.
If OSA is suspected during the pre-operative evaluation, you can proceed with a presumptive diagnosis of OSA, albeit with caution. If a
patient is on pre-operative CPAP, assess and encourage adherence to
CPAP. Make sure that the surgical team is aware of the patient's status.
Educate the patient and his caregiver(s) regarding the potential concerns, the use of non-opioid analgesics and avoidance of opioids postop, and that the patient should sleep propped up, if possible, after surgery. Reiterate these concerns and instructions after surgery as well.
2. Intraop actions
Use regional anesthetic techniques whenever possible in patients with
OSA. If general anesthesia has to be used, choose a technique that
allows early emergence.
Minimize perioperative opioid use, as these drugs have a depressive
effect on the respiratory system, and patients with OSA are already coming to you compromised in this area. Instead, employ a multi-modal, non9 4
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
