OBSTRÜKTİF UYKU APNE SENDROMUNDA İNTRAOPERATİF VE POSTOPERATİF SÜREÇLERDE ANESTEZİSTİN ROLÜ

Obstrüktif uyku apne sendromu (OUAS)’lu hastalarda genel anestezi ile ilgili endişeler, hava yoluzorluğunun artması ve anestezik ajanların artık etkisinden dolayı solunum aktivitesinde oluşabilecek uzamış solunum depresyonu olasılığıdır. Genel anestezi planlamadan önce hastalar zorhavayolu idaresi için dikkatle değerlendirilmelidir. Genel anestezi planlandığında, bölgesel birteknik eklenmesi opioid gereksinimini azaltabilir.

The Role of Anesthesiologist in Intraoperative and Postoperative Processes in Obstructive Sleep Apnea Syndrome

Concerns with general anesthesia in patients with OSA include the increased incidence of airway difficulty and the potential for delayed respiratory depression due to residual anesthetic agents. Before choosing general anesthesia, patients should be carefully assessed for potentially difficult airway management. When general anesthesia is planned, the addition of a regional technique may decrease opioid requirements.

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  • 1. Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008; 107: 1543-63.
  • 2. Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hironi A, Leiby B, et al. Obstructive sleep apnea syndome and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg 2010;136(10):1020-4.
  • 3. Adesanya AO1, Lee W, Greilich NB, Joshi GP. Perioperative management of obstructive sleep apnea. Chest. 2010; 138: 1489-98.
  • 4. American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014; 120: 268-86.
  • 5. -Finkel KJ, Searleman AC, Tymkev H, Tanaka CY, Saager L, SaferZadeh E, et al. Prevelance of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med 2009;10(7):753-8.
  • 6. Hiremath AS1, Hillman DR, James AL, Noffsinger WJ, Platt PR, Singer SL. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth. 1998; 80: 606-11.
  • 7. Lee SJ, Lee JN, Kim TS, Park YC. The relationship between the predictors of obstructive sleep apnea and difficult intubation. Korean J Anesthesiol. 2011; 60: 173-8.
  • 8. Magalhães E, Oliveira Marques F, Sousa Govêia C, Araujo Ladeira LC, Lagares J. Use of simple clinical predictors on preoperative diagnosis of difficult endotracheal intubation in obese patients. Braz J Anesthesiol. 2013; 63: 262-6.
  • 9. Neligan PJ, Porter S, Max B, Malhotra G, Greenblatt EP, Ochroch EA. Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients. Anesth Analg 2009; 109: 1182-6.
  • 10. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Eng J Med 1993;328(17):1230-5.
  • 11. American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2014; 120:268.
  • 12. Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg 2008; 107:1543.
  • 13. Eastwood PR, Platt PR, Shepherd H, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentration of propofol anesthesia. Anesthesiology 2005;103(3):470-7.
  • 14. Memtsoudis SG, Stundner O, Rasul R, et al. Sleep apnea and total joint arthroplasty under various types of anesthesia: a population-based study of perioperative outcomes. Reg Anesth Pain Med 2013; 38:274.
  • 15. Hillman DR, Platt PR, Eastwood PR. The upper airway during anaesthesia. Br J Anaesth 2003; 91:31.
  • 16. Seet E, Han TL, Chung F. Perioperative Clinical Pathways to Manage Sleep-Disordered Breathing. Sleep Med Clin 2013; 8:105.
  • 17. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118:251.
  • 18. Sato Y, Ikeda A, Ishikawa T, Isono S. How can we improve mask ventilation in patients with obstructive sleep apnea during anesthesia induction? J Anesth 2013; 27:152.
  • 19. Delay JM, Sebbane M, Jung B, et al. The effectiveness of noninvasive positive pressure ventilation to enhance preoxygenation in morbidly obese patients: a randomized controlled study. Anesth Analg 2008; 107:1707.
  • 20. Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology 2000; 92:1229.
  • 21. Kheterpal S, Martin L, Shanks AM, Tremper KK. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology 2009; 110:891.
  • 22. Meoli AL, Rosen CL, Kristo D, et al. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period--avoiding complications. Sleep 2003; 26:1060.
  • 23. Ramachandran SK, Mathis MR, Tremper KK, et al. Predictors and clinical outcomes from failed Laryngeal Mask Airway Unique™: a study of 15,795 patients. Anesthesiology 2012; 116:1217.
  • 24. Eric Olson, Frances Chung,Edwin Seet, MMedIntraoperative management of adults with obstructive sleep apnea (2016) https:// www.uptodate.com/contents/intraoperative-management-ofadults-with-obstructive-sleep-apnea
  • 25. Parmet JL, Colonna-Romano P, Horrow JC, et al. The laryngeal mask airway reliably provides rescue ventilation in cases of unanticipated difficult tracheal intubation along with difficult mask ventilation. Anesth Analg 1998; 87:661.
  • 26. Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg 2002; 95:1098.
  • 27. Ezri T, Medalion B, Weisenberg M, et al. Increased body mass index per se is not a predictor of difficult laryngoscopy. Can J Anaesth 2003; 50:179.
  • 28. Kim JA, Lee JJ. Preoperative predictors of difficult intubation in patients with obstructive sleep apnea syndrome. Can J Anaesth 2006; 53:393.
  • 29. Hiremath AS, Hillman DR, James AL, et al. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 1998; 80:606.
  • 30. Chung F, Yegneswaran B, Herrera F, et al. Patients with difficult intubation may need referral to sleep clinics. Anesth Analg 2008; 107:915.
  • 31. Chau EH, Lam D, Wong J, et al. Obesity hypoventilation syndrome: a review of epidemiology, pathophysiology, and perioperative considerations. Anesthesiology 2012; 117:188.
  • 32. Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg 2010; 111:120.
  • 33. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85:109.
  • 34. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 2002; 89:622.
  • 35. Lam T, Singh M, Yadollahi A, Chung F. Is Perioperative Fluid and Salt Balance a Contributing Factor in Postoperative Worsening of Obstructive Sleep Apnea? Anesth Analg 2016; 122:1335.
  • 36. Bolden N, Smith CE, Auckley D, et al. Perioperative complications during use of an obstructive sleep apnea protocol following surgery and anesthesia. Anesth Analg 2007; 105:1869.
  • 40. Chung F, Liao P, Elsaid H, et al. Factors associated with postoperative exacerbation of sleep-disordered breathing. Anesthesiology 2014; 120:299.
  • 41. Ankichetty S, Wong J, Chung F. A systematic review of the effects of sedatives and anesthetics in patients with obstructive sleep apnea. J Anaesthesiol Clin Pharmacol 2011; 27:447.
  • 42. Eikermann M, Grosse-Sundrup M, Zaremba S, et al. Ketamine activates breathing and abolishes the coupling between loss of consciousness and upper airway dilator muscle dysfunction. Anesthesiology 2012; 116:35.
  • 43. American Society of Anesthesiologists Task Force on Neuraxial Opioids, Horlocker TT, Burton AW, et al. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. Anesthesiology 2009; 110:218.
  • 44. de Leon-Casasola OA, Lema MJ. Postoperative epidural opioid analgesia: what are the choices? Anesth Analg 1996; 83:867.
  • 45. Bujedo BM, Santos SG, Azpiazu AU. A review of epidural and intrathecal opioids used in the management of postoperative pain. J Opioid Manag 2012; 8:177.
  • 43. STANDARDS FOR POSTANESTHESIA CARE (2009) http://www. asahq.org/For-Members/Standards-Guidelines-and-Statements. aspx (Accessed on February 13, 2014).
  • 44. American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2014; 120:268.
  • 45. Weinger MB, Lee LA. "No Patient Shall be Harmed by OpioidInduced Respiratory Depression" [Proceedings of "Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Perios" Conference]. APSF Newsletter 2011; 26:21. Available at: http://www.apsf.org/ newsletters/pdf/fall_2011.pdf (Accessed on December 05, 2013).
  • 46. Adesanya AO, Lee W, Greilich NB, Joshi GP. Perioperative management of obstructive sleep apnea. Chest 2010; 138:1489.
  • 47. Nagappa M, Mokhlesi B, Wong J, et al. The Effects of Continuous Positive Airway Pressure on Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing Surgery: A Systematic Review and Meta-analysis. Anesth Analg 2015; 120:1013.
  • 48. Weingarten TN, Flores AS, McKenzie JA, et al. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth 2011; 106:131.
  • 49. Liao P, Luo Q, Elsaid H, et al. Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: a randomized controlled trial. Anesthesiology 2013; 119:837.
  • 50. O'Gorman SM, Gay PC, Morgenthaler TI. Does autotitrating positive airway pressure therapy improve postoperative outcome in patients at risk for obstructive sleep apnea syndrome? A randomized controlled clinical trial. Chest 2013; 144:72.
  • 51. Squadrone V, Coha M, Cerutti E, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 2005; 293:589.
  • 52. Zarbock A, Mueller E, Netzer S, et al. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest 2009; 135:1252.
  • 53. Kindgen-Milles D, Müller E, Buhl R, et al. Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest 2005; 128:821.
  • 54. Huerta S, DeShields S, Shpiner R, et al. Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after Roux-en-Y gastric bypass. J Gastrointest Surg 2002; 6:354.
  • 55. Jokic R, Klimaszewski A, Crossley M, et al. Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. Chest 1999; 115:771.
  • 56. Ong JS, Touyz G, Tanner S, et al. Variability of human upper airway collapsibility during sleep and the influence of body posture and sleep stage. J Sleep Res 2011; 20:533.
  • 57. Chung F, Liao P, Yegneswaran B, et al. Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology 2014; 120:287.
  • 58. Seet E, Chung F. Management of sleep apnea in adults - functional algorithms for the perioperative period: Continuing Professional Development. Can J Anaesth 2010; 57:849.
  • 59. Gali B, Whalen FX, Schroeder DR, et al. Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology 2009; 110:869.
  • 60. Swart P, Chung F, Fleetham J. An order-based approach to facilitate postoperative decision-making for patients with sleep apnea. Can J Anaesth 2013; 60:321.