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Alp ID, Köksal BG, Bollucuoğlu K, Küçükosman G, Pişkin Ö, Baytar Ç, Okyay RD, Ayoğlu H. Evaluation of the relationship between the STOP-Bang score with oxygen reserve index and difficult airway: a prospective observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744453. [PMID: 37517587 PMCID: PMC11148496 DOI: 10.1016/j.bjane.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Patients diagnosed with Obstructive Sleep Apnea (OSA) syndrome have a tendency towards hypoventilation, hypoxia, and hypercarbia in the perioperative period. This study hypothesized that the Oxygen Reserve Index (ORi) could predict possible hypoxia and determine difficult airways in patients at risk for OSA, as determined by the STOP-Bang questionnaire. METHODS This prospective study included adult patients undergoing elective surgery under general anesthesia with endotracheal intubation, divided into two groups: low risk (0-2 points) and high risk (3-8 points) based on their STOP-Bang questionnaire results. The primary outcome measure was the highest ORi value reached during preoxygenation and the time to reach this value. Data were recorded at four time points: before preoxygenation (T1), end of preoxygenation (T2), end of mask ventilation (T3), and end of intubation (T4), as well as partial oxygen pressure values in T1, T2, and T4. The secondary outcome measures were the grading scale for mask ventilation, Cormack-Lehane score, tonsil dimensions, use of a stylet, and application of the burp maneuver during intubation. RESULTS In the high-risk group, preoperative peripheral oxygen saturation values, the highest ORi value reached in preoxygenation, and ORi values at T3 and T4 times were lower, and the time to reach the highest ORi value was longer (p < 0.05). CONCLUSION Using ORi in patients with OSA may be useful in evaluating oxygenation, and since difficult airway is more common, ORi monitoring will better manage possible hypoxic conditions.
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Affiliation(s)
- Ilka D Alp
- Zonguldak Bülent Ecevit University Medical School, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
| | - Bengü G Köksal
- Zonguldak Bülent Ecevit University Medical School, Department of Anesthesiology and Reanimation, Zonguldak, Turkey.
| | - Keziban Bollucuoğlu
- Zonguldak Bülent Ecevit University Medical School, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
| | - Gamze Küçükosman
- Zonguldak Bülent Ecevit University Medical School, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
| | - Özcan Pişkin
- Zonguldak Bülent Ecevit University Medical School, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
| | - Çağdaş Baytar
- Zonguldak Bülent Ecevit University Medical School, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
| | - Rahşan D Okyay
- Zonguldak Bülent Ecevit University Medical School, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
| | - Hilal Ayoğlu
- Zonguldak Bülent Ecevit University Medical School, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
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2
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Azizad O, Joshi GP. Day-surgery adult patients with obesity and obstructive sleep apnea: Current controversies and concerns. Best Pract Res Clin Anaesthesiol 2023; 37:317-330. [PMID: 37938079 DOI: 10.1016/j.bpa.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Obesity and obstructive sleep apnea are considered independent risk factors that can adversely affect perioperative outcomes. A combination of these two conditions in the ambulatory surgery patient can pose significant challenges for the anesthesiologist. Nevertheless, these patients should not routinely be denied access to ambulatory surgery. Instead, patients should be appropriately optimized. Anesthesiologists and surgeons must work together to implement fast-track anesthetic and surgical techniques that will ensure successful ambulatory outcomes.
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Affiliation(s)
- Omaira Azizad
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bae E. Preoperative risk evaluation and perioperative management of patients with obstructive sleep apnea: a narrative review. J Dent Anesth Pain Med 2023; 23:179-192. [PMID: 37559666 PMCID: PMC10407451 DOI: 10.17245/jdapm.2023.23.4.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.
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Affiliation(s)
- Eunhye Bae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Republic of Korea
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4
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Perioperative considerations for adult patients with obstructive sleep apnea. Curr Opin Anaesthesiol 2022; 35:392-400. [PMID: 35671031 DOI: 10.1097/aco.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is a common, but often undiagnosed, sleep breathing disorder affecting approximately a third of adult surgical patients. OSA patients have increased sensitivity to anesthetic agents, sedatives, and opioid analgesics. RECENT FINDINGS Newer technologies (e.g., bedside capnography) have demonstrated that OSA patients have repetitive apneic spells, beginning in the immediate postoperative period and peaking in frequency during the first postoperative night. Compared to patients without OSA, OSA patients have double the risk for postoperative pulmonary as well as other complications, and OSA has been linked to critical postoperative respiratory events leading to anoxic brain injury or death. Patients with OSA who have respiratory depression during anesthesia recovery have been found to be high-risk for subsequent pulmonary complications. Gabapentinoids have been linked to respiratory depression in these patients. SUMMARY Surgical patients should be screened for OSA and patients with OSA should continue using positive airway pressure devices postoperatively. Use of shorter acting and less sedating agents and opioid sparing anesthetic techniques should be encouraged. In particular, OSA patients exhibiting signs of respiratory depression in postanesthesia recovery unit should receive enhancer respiratory monitoring following discharge to wards.
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Wu YM, Su YH, Huang SY, Wang CW, Shen SC, Chen JT, Lo PH, Cherng YG, Wu HL, Tai YH. Morphometric and ultrasonographic determinants of difficult laryngoscopy in obese patients: A prospective observational study. J Chin Med Assoc 2022; 85:571-577. [PMID: 35385418 DOI: 10.1097/jcma.0000000000000721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Obese people have a higher risk of difficult laryngoscopy due to their thick neck, large tongue, and redundant pharyngeal soft tissue. However, there is still no established predictive factor for difficult laryngoscopy in obese population. METHODS We conducted a prospective assessor-blind observational study to enroll adult patients with a body mass index of 30 kg·m-2 or higher undergoing laparoscopic sleeve gastrectomy at a medical center between May 2020 and August 2021. Conventional morphometric characteristics along with ultrasonographic airway parameters were evaluated before surgery. The primary outcome was difficult laryngoscopy, defined as a Cormack and Lehane's grade III or IV during direct laryngoscopy. Logistic regression analyses were performed to evaluate the association between included factors and difficult laryngoscopy. Discrimination performance of predictive factors was assessed using area under the receiver operating characteristic curve (AUC). RESULTS A total of 80 patients were evaluated, and 17 (21.3%) developed an event of difficult laryngoscopy. Univariate analyses identified five factors associated with difficult laryngoscopy, including age, sex, hypertension, neck circumference, and cross-sectional area of tongue base. After adjusting for these variables, neck circumference was the only independent influential factor, adjusted odds ratio: 1.227 (95% confidence interval, 1.009-1.491). Based on Youden's index, the optimal cutoff of neck circumference was 49.1 cm with AUC: 0.739 (sensitivity: 0.588, specificity: 0.889; absolute risk difference: 0.477, and number needed to treat: 3). CONCLUSION Greater neck circumference was an independent risk factor for difficult laryngoscopy in obese patients. This finding provides a way of reducing unanticipated difficult airway in this high-risk population.
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Affiliation(s)
- Yu-Ming Wu
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yen-Hao Su
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Shih-Yu Huang
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chien-Wun Wang
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Shih-Chiang Shen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Jui-Tai Chen
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Po-Han Lo
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
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Seet E, Saw CJ, Kumar CM. Obstructive sleep apnea and perioperative management of the difficult airway. Int Anesthesiol Clin 2022; 60:35-42. [PMID: 35261344 DOI: 10.1097/aia.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
- Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Chen JL, Moon TS, Schumann R. Bariatric surgery in patients with obstructive sleep apnea. Int Anesthesiol Clin 2022; 60:50-58. [PMID: 35125481 DOI: 10.1097/aia.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Joy L Chen
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tiffany S Moon
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roman Schumann
- Department of Anesthesiology, Critical Care and Pain Medicine, VA Boston Healthcare System, Boston, Massachusetts
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8
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Azizad O, Joshi GP. Ambulatory surgical patients and sleep apnea. Int Anesthesiol Clin 2022; 60:43-49. [PMID: 35180144 DOI: 10.1097/aia.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Omaira Azizad
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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Singh P, Liew W, Negar A. Airway management in patients suffering from morbid obesity. Saudi J Anaesth 2022; 16:314-321. [PMID: 35898526 PMCID: PMC9311184 DOI: 10.4103/sja.sja_90_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
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Moon T, Oh M, Chen J. Patients with sleep-disordered breathing for bariatric surgery. Saudi J Anaesth 2022; 16:299-305. [PMID: 35898522 PMCID: PMC9311179 DOI: 10.4103/sja.sja_300_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 11/04/2022] Open
Abstract
The prevalence of patients with obesity continues to rise worldwide and has reached epidemic proportions. There is a strong correlation between obesity and sleep-disordered breathing (SDB), and, in particular, obstructive sleep apnea (OSA). OSA is often undiagnosed in the surgical population. Bariatric surgery has been recognized as an effective treatment option for both obesity and OSA. Laparoscopic bariatric procedures, particularly laparoscopic sleeve gastrectomy (LSG), have become the most frequently performed procedures. OSA has been identified as an independent risk factor for perioperative complications and failure to recognize and prepare for patients with OSA is a major cause of postoperative adverse events, suggesting that all patients undergoing bariatric surgery should be screened preoperatively for OSA. These patients should be treated with an opioid-sparing analgesic plan and continuous positive airway pressure (CPAP) perioperatively to minimize respiratory complications. With the number of bariatric surgical patients with SDB likely to continue rising, it is critical to understand the best practices to manage this patient population.
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Beetz G, Herrero Babiloni A, Jodoin M, Charlebois-Plante C, Lavigne GJ, De Beaumont L, Rouleau DM. Relevance of Sleep Disturbances to Orthopaedic Surgery: A Current Concepts Narrative and Practical Review. J Bone Joint Surg Am 2021; 103:2045-2056. [PMID: 34478407 DOI: 10.2106/jbjs.21.00176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Sleep disturbances can increase the risk of falls and motor vehicle accidents and may reduce bone density. ➤ Poor sleep can lead to worse outcomes after fracture, such as chronic pain and delayed recovery. ➤ Orthopaedic surgeons can play an important role in the screening of sleep disorders among their patients.
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Affiliation(s)
- Gabrielle Beetz
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Alberto Herrero Babiloni
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Marianne Jodoin
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | | | - Gilles J Lavigne
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Dominique M Rouleau
- Montreal Sacré-Coeur Hospital, Montreal, Quebec, Canada.,Department of Surgery, University of Montreal, Montreal, Quebec, Canada
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