J U LY 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 5 5
general anesthesia is needed, make sure your providers have the tools and tech-
niques to secure the airway. Finally, unless a contraindication exists, OSA
patients should be extubated while fully awake.
4. Stay vigilant in recovery. Whenever possible, say the ASA
guidelines, the patient should be in the lateral or semi-upright position during
extubation and recovery. Administer supplemental O
2
until patients are able to
maintain baseline oxygen saturation levels while breathing on their own.
Continue use of CPAP in post-op if the patient uses the device pre-operatively.
If patients have sleep apnea equipment at home, by all means have them
bring it with them on the day of surgery. Familiarity can only help. And since
they'll use the same equipment at home, you'll know that if they can't be safe-
ly managed in recovery, they're not going to tolerate it at home, either.
Patients should not be discharged to home until they're no longer at risk of
experiencing respiratory depression or airway obstruction. Making that cru-
cial decision may require a longer stay in PACU for extended monitoring.
5. Err on the side of caution. Judgment and communication are
the essential elements of safe perioperative care. The diagnosis that a sleep
apnea patient is a candidate for surgery needs to be followed by appropriate
intraoperative monitoring and post-op care. And everybody needs to agree
that discharging the OSA patient is safe.
OSM
Dr. Baugh (reginald.baugh@utoledo.edu) is an
ENT-otolaryngologist and a professor of surgery at the
University of Toledo College of Medicine and Life Sciences in Toledo, Ohio.
