priate to discontinue. Keep positive airway pressure (PAP) machines
in stock for use post-operatively in undiagnosed OSA patients or OSA
patients that don't bring their CPAP machines with them.
While administering analgesics, post-operative staff should be vigi-
lant to observe for bradypnea, apnea, inability to wean from oxygen,
and low or decreasing arterial oxygen saturations. If a patient has no
respiratory events in PACU, the American Society of Anesthesia
guidelines recommend he stays in recovery for a minimum of 3 hours.
If there are any observed respiratory events, the guidelines recom-
mend a minimum of 7 hours in the PACU. Ultimately, the decision of
whether to discharge patients is up to the practitioner and should be
based on the type of procedure, the type of anesthesia, the level of
pain, their age and what kind of care they'll be receiving at home. In
the case that respiratory events don't resolve, you may want to con-
sider admitting the patient to the hospital with continuous SpO
2
and
end tidal CO
2
monitoring. Any patient who's screened as high-risk for
OSA should have follow-up and referral to have formal polysomnogra-
phy and receive a formal diagnosis.
OSM
5 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 7
Mr. Schmidt (timschmidtcrna@gmail.com) is the owner of Sonno Anesthesia in
St. Petersburg, Fla.
