3. Know how to properly
screen your patients for OSA
Commit a thorough pre-operative review of all patients to determine
whether a patient has OSA and to what severity it is. You should
review all medical records, physical examinations, sleep studies and
any X-rays. Even if you do a thorough pre-op review of a patient, the
majority of patients with OSA will lack a formal diagnosis. The gold-
standard for the diagnosis of OSA is polysomnography (PSG). How-
ever, PSG is fairly expensive and there can be a wait time anywhere
from 2-10 months, making it unlikely that most outpatients will have
had a PSG done.
Anesthesia providers can use the STOP-Bang Questionnaire to
screen patients for sleep apnea risk factors and severity, and to
develop a care plan that will lead to a safe anesthetic outcome.
STOP-Bang asks patients to self-report things like snoring, apneic
episodes and daytime somnolence, as well as physical characteris-
tics such as BMI and neck circumference, gender, age and airway
anomalies. I've often found that many of my patients don't realize
whether they snore or if they have apneic episodes, so I'll ask their
partners or family members that are present — many times you will
get a very enthusiastic yes from their loved ones. Flag patients who
you determine to be at high risk so that you can make the appropri-
ate modifications both intraoperatively and post-operatively.
4. Your intraoperative game plan
The key to your intraoperative game plan is avoiding IV and volatile
anesthetics whenever possible or otherwise using them sparingly.
Almost all IV and volatile anesthetics are muscle relaxants and res-
piratory depressants. If a general anesthetic is required, try to use
shorter-acting anesthetic agents and agents that are metabolized
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