Airway Management for Patients with Sleep Apnea

Obstructive sleep apnea (OSA) is a persistent medical situation that impacts an individual’s nighttime respiration. This may result in fatigue, dry mouth, and points with daytime wakefulness. Sleep apnea additionally correlates with a better threat of great well being issues, together with stroke, coronary heart assault, respiratory illness, pneumonia, and untimely loss of life.


Airway administration for sleep apnea sufferers focuses on serving to them breathe higher at night time, thereby lowering their threat of great compilations. Nonetheless, surgical sufferers with OSA could current with tough airways, and sleep apnea could complicate surgical restoration. Right here’s what it’s good to find out about airway administration for sufferers with sleep apnea. 


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 Managing Sleep Apnea Sufferers Earlier than Surgical procedure

In presurgical consultations, it’s essential to ask sufferers about any historical past of sleep apnea, in addition to how effectively that sleep apnea has been managed. Sufferers ought to carry any gadgets they use with them to their hospital keep, and suppliers ought to seek the advice of with the physician treating the sleep apnea. Ask concerning the earlier use of anesthesia, together with any historical past of anesthesia or postsurgical issues.


Some methods that may guarantee high quality take care of sleep apnea sufferers embody:


  • Assessing the airway earlier than intubating and planning accordingly
  • Selecting the supplier who’s probably the most expert at working with tough airways
  • Avoiding stigma; don’t deal with sleep apnea sufferers as an annoyance or inconvenience, and by no means make sufferers really feel judged for his or her weight, which can trigger them to keep away from medical care sooner or later
  • Evaluating a affected person’s threat of apnea-related occasions previous to surgical procedure
  • Offering acceptable monitoring after surgical procedure
  • Utilizing steady optimistic airway stress (CPAP) machines postoperatively to cut back the danger of desaturation and apnea occasions 


Perioperative Sleep Apnea Airway Problems 

A historical past of sleep apnea will increase the danger of a tough airway. In a research of sleep apnea, sufferers present process basic anesthesia earlier than surgical procedure, 43% have been categorized as Cormack-Lehane grade 1, with one other 43% categorized as grade 2. Fourteen p.c have been grade 3. This means a better price of doubtless tough airways than within the basic inhabitants. 


The research confirmed that 27% skilled apnea or occasions of desaturation within the postanesthesia care unit (PACU), confirming the hyperlink between sleep apnea and a better price of anesthesia-related airway difficulties. Sleep apnea sufferers additionally required longer stays within the PACU on common, in addition to extra hospital sources.


The Significance of Discharge Planning 

Sleep apnea correlates with a better physique mass index (BMI), which signifies that for a lot of sufferers, dropping pounds could cut back sleep apnea signs. Suppliers ought to seek the advice of with sufferers about their postsurgical sleep apnea therapy choices, together with life-style modifications to help a wholesome weight and higher sleep apnea administration. Advise sufferers to proceed utilizing their CPAP machine or different sleep apnea tools. 


Sufferers who’re newly identified with sleep apnea or who will not be treating it at house want follow-up care. Most will want a CPAP machine, however laser surgical procedure and oral home equipment to guard the airway may assist. Emphasize to those sufferers that correct administration of their situation could enhance their restoration and cut back the necessity for extra future medical interventions. 


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Selecting the Proper Tools

Sleep apnea is usually benign, however within the perioperative setting, it could actually result in severe emergencies and make anesthesia extra sophisticated. Left untreated, it could actually put a affected person at increased threat of great and life-threatening medical situations. The power to shortly reply to emergencies can save a affected person’s life and should cut back pointless reliance on scarce medical sources.


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Editor’s Be aware: This weblog was initially printed in January 2021. It has been re-published with extra updated content material.



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