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ever possible and titrate any opioids to make
the patient comfortable, not to achieve a particular pain score. Balance the degree of pain with
concerns about sedation and respiratory
depression. Regional blocks can be placed postop to provide safer, long-lasting pain relief.
Monitor the patient in PACU until he is completely awake and maintains SaO2 at baseline.
Exercise caution in OSA patients who develop
prolonged and frequent severe respiratory
events (such as sedation/ analgesic mismatch,
desaturation, and hyponeic or apneic episodes)
in the post-operative period. Most adverse
events occur within 2 hours after surgery, so
keeping close watch is of particular import.
Ask patients placed on an OSA protocol
based on clinical indicators to follow up with
their primary physicians for a possible sleep
study. Instruct patients on pre-operative CPAP
that they should use CPAP when sleeping, daytime or nighttime. Finally, tell OSA patients to
avoid opioids if possible, and not to take sedatives and/or muscle relaxants. OSM
Dr. Joshi (girish.joshi@utsouthwestern.edu) is
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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
