OSA and PACU by chenshu


									                         OBSTRUCTIVE SLEEP APNEA & THE PACU

What is the definition of obstructive sleep apnea (OSA)?
OSA is a syndrome characterized by periodic, partial, or complete obstruction of the upper
airway during sleep. This causes repetitive arousal from sleep to restore airway patency which
may result in daytime hypersomnolence.

What are the clinical signs and symptoms suggesting OSA?
Physical Characteristics: Obesity (BMI > 35), large neck circumference (> 17” in men, 16” in
women), craniofacial abnormalities, anatomic nasal obstruction, tonsils touching midline
History: snoring, pauses in breathing during sleep, wakes with choking sensation, frequent
arousals from sleep, frequent daytime somnolence, especially in nonstimulating environment.
Peds: intermittent vocalization during sleep, observed restless sleep, daytime sleepiness, easily
Diagnosis: Presumptive diagnosis can be made with history or Sleep study (apnea-hypopnea
index), grade severity

What factors associated with OSA patients increase their risk of morbidity during the post-
operative period?
   1. Severity of sleep apnea
   2. Type of Surgery (airway surgery versus peripheral surgery)
   3. Type of Anesthesia (local anesthetic versus sedation versus general anesthesia)
   4. Opioid requirements (none versus low dose oral versus high dose oral or parenteral or
       neuraxial opioids)
   - These factors are numerically graded with severity and a perioperative risk score is

What if the patient uses a CPAP at home to treat OSA?
The patient should bring in the CPAP and utilize it during the post-operative period.

What patient position should be avoided in OSA patients in the post-operative period?

How does your management and discharge criteria in the PACU change if the patient has
OSA and undergoes general anesthesia?
Patient should be monitored for an extra 3 hours during the post-operative period. If the
saturations stay above 90% at rest without supplemental oxygen, the patient could be discharged
home otherwise the patient should be admitted to a monitored floor at UCLA.

UCLA Guidelines for Perioperative Care of Patients with Obstructive Sleep Apnea.
ASA Taskforce on Perioperative Management of Patients with Obstructive Sleep Apnea. Practice guidelines for the
perioperative management of patients with obstructive sleep apnea. Anesthesiology 104; 1081-1093. 2006

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