While the STOP BANG scoring system is a good indicator, he says,
there are also other factors (such as airway abnormalities), and some
items might be assigned greater values than 1. For instance, being male
and having a BMI above 35 are more important considerations than
age and neck circumference.
There are different schools of thought on discharging obese/OSA
patients, says Mr. Ruspantine. Awake patients should be kept in
Fowler's position with minimal reliance on nasal cannula. Low flows
are best, so as not to suppress the respiratory drive. Additionally,
there's no evidence that longer postoperative stays are beneficial;
patients can be discharged when their baseline Sa0
2
returns to normal
on room air.
3. PONV
In the fight against post-operative and post-discharge nausea and
vomiting, there are now so many weapons that no potential outpatient
needs to be off limits on that basis alone, says anesthesiologist Jeffrey
Cazier, MD.
"I have patients who say they've gotten sick every time. I view that
as a challenge," says Dr. Cazier, the medical director of the Surgery
Center of Huntsville, Ala. "It's gratifying when they call several days
later and ask for the anesthetic records, saying, 'That's the first time I
didn't get sick, I want to see what you gave me, so I can get it when I
go other places.'"
What he gives them is whatever's necessary, depending on the circum-
stances. It's about recognizing risk factors and responding appropriately,
he says. As spelled out in the most recent "Consensus Guidelines for the
Management of Postoperative Nausea and Vomiting" (osmag.net/tefs4t), the
key risk factors for adults include being female, having a history of
PONV and/or motion sickness, being a non-smoker and postoperative
1 0 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 6
