5 4 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 5
discussion. Recovery room nurses need to provide reliable feedback: How well
did the patient recover from anesthesia? How did he respond to narcotics?
If surgeons and anesthesiologists disagree about the efficacy of a given case, the
best approach is to go ahead when things are optimized. That may mean postpon-
ing surgery until you have additional information from a sleep apnea evaluation or
a formal sleep study, but you want to have a plan. You want to say patients can go
home once they meet certain criteria.
3. Regional is preferred. All narcotics have the potential to sup-
press respiration and increase risk. The more narcotics patients receive, the
more likely it is they'll have airway trouble. Employing local blocks whenever
possible can minimize a patient's reliance on opioids to manage post-op pain.
For patients with severe sleep apnea, sedation and pain meds can turn a bad
airway into no airway. If you can't establish an airway, you shouldn't do the pro-
cedure in an ASC. It's a mistake to say, this patient is a difficult intubation, so
we're going to use regional. If something goes wrong, you may have to intubate.
If the patient's bad airway was the reason you chose regional, you've put your-
self behind the eight ball.
According to the ASA's practice guidelines, local anesthesia or peripheral
nerve blocks with or without moderate sedation should be considered for super-
ficial procedures. Regional anesthesia is preferable for mild sleep apnea
patients, because the more the patient breathes on his own, the safer the airway.
Another concern would be an extremity procedure with a regional block on a
patient with unrecognized sleep apnea. If the head is in a dependent position
and the procedure lasts longer than expected, passive swelling of the orophar-
ynx may cause mild sleep apnea to progress to significant obstructive sleep
apnea.
When moderate sedation is employed, the use of capnography is an effective
way to determine if ventilation is adequate. Additionally, a patient's CPAP
machine can be used during administration of sedation to improve breathing. If
