Outpatient Surgery Magazine

Did Skin Prep Fuel This Fire? - February 2017 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 133 of 146

patients (those with BMIs of 40 or higher) have OSA, and 10% to 20% of those have obesity hypoventilation syndrome. Morbidly obese patients are also more susceptible to thromboembolic, infectious and surgical complications, and OSA increases those risks. • Screen high-risk patients. Identifying high-risk patients for pre- cautions and interventions can be burdensome, but a growing consen- sus believes that attempting to do so may reduce complications. For example, evidence supports avoiding general anesthesia in OSA patients undergoing specific procedures, such as joint arthroplasty. Additionally, since OSA can affect respiratory outcomes and promote post-operative cardiovascular events, it may be wise to consider moni- toring both cardiac and respiratory function for OSA patients who have pulmonary hypertension and/or heart disease, both of which are common comorbidities. Excessive daytime sleepiness and habitual snoring are classic symp- toms of undiagnosed OSA patients, but numerous factors also increase the risk, including alcohol; smoking; obesity; increased neck circumference; male sex; advanced age; enlarged tonsils, adenoids and tongues; nasal obstruction; and craniofacial abnormalities. • Recognize screening's limitations. Sleep testing, such as an overnight polysomnography, is the only completely accurate way to diagnose OSA, but because many patients are screened on the day of surgery, or only a day or 2 before, you'll likely have to rely on ques- tionnaires or simple clinical models, which aren't 100% accurate. Among current screening tools, STOP-Bang (osmag.net/fgtkk8) is the most validated in surgical patients (a score of 4 has a high sensi- tivity of 88% for identifying patients with severe OSA), and it has also been validated in sleep clinic patients and the general population. It's not perfect, but it adds clinical value to the pre-operative assessment and is a relatively easy way to determine risk. Other screening tools Anesthesia Alert AA 1 3 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 • J A N U A R Y 2 0 1 7

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