Review article
OBSTRUCTIVE SLEEP APNEA, ANESTHESIA AND AIRWAY – CLINICAL DILEMMAS AND REVIEW OF THE LATEST GUIDELINES
MLADEN CAREV
orcid.org/0000-0003-2209-9331
; Split University Hospital Centre, Department of Anesthesiology and Intensive Care Medicine, Split, University of Split, School of Medicine, Department of Anesthesiology and Intensive Medicine, Split, Croatia
ZORAN ĐOGAŠ
orcid.org/0000-0003-3138-3887
; University of Split, School of Medicine, Department of Neuroscience, Center for Sleep Medicine, Split, Croatia
ŽELJKO NINČEVIĆ
orcid.org/0000-0001-9087-1368
; Split University Hospital Centre, Department of Anesthesiology and Intensive Care Medicine, Split, University of Split, School of Medicine, Department of Anesthesiology and Intensive Medicine, Split, Croatia
SANDA STOJANOVIĆ STIPIĆ
; Split University Hospital Centre, Department of Anesthesiology and Intensive Care Medicine, Split, University of Split, School of Medicine, Department of Anesthesiology and Intensive Medicine, Split, Croatia
NENAD KARANOVIĆ
; Split University Hospital Centre, Department of Anesthesiology and Intensive Care Medicine, Split, University of Split, School of Medicine, Department of Anesthesiology and Intensive Medicine, Split, Croatia
Abstract
The aim of this review article is to explain the anesthetic approach to patients with obstructive sleep apnea (OSA), to show results of the most recent research, and to review the recently published guidelines and recommendations. OSA is the most common sleep-related breathing disorder. It is considered that OSA is a systemic disease with many different phenotypes and pathophysiological mechanisms. It has been shown that patients with OSA have an increased incidence of perioperative adverse events, especially those associated with maintaining the airway. Patients with OSA are sensitive to conventional
anesthetics and sedatives, particularly opioids. Therefore, in these patients, local and regional techniques should be applied whenever possible. Among surgical patients, there is a high prevalence of OSA, and a large number of patients are not diagnosed preoperatively. Defi nitive OSA diagnosis is only possible with polysomnography, which is not always easily available. Therefore, the use of various validated preoperative tests and questionnaires (STOP BANG, Berlin, ASA, P-SAP) is increasingly recommended today, as these correlate satisfactorily with postoperative outcomes and help in preoperative risk stratification. In the last years, two new important documents have appeared. The practice guidelines for the perioperative management of patients with obstructive sleep apnea were published by the American Society of Anesthesiologists (ASA) in 2014, and the Recommendations of the American Association for Anesthesiology and Sleep Medicine two years later. The latter are practical because they classify patients into 3 groups: 1) surgical patients with OSA, adherent to positive airway pressure (PAP) therapy, 2) surgical patients with OSA, who decline or are poorly adherent to PAP therapy, and 3) surgical patients who have a high probability of OSA. These recommendations defi ne the term of uncontrolled systemic disease for the fi rst time. Furthermore, this new structured approach gives clear recommendations in addition to the current ASA guidelines from 2014.
Keywords
sleep apnea; questionnaire; surgery; complications; airway; guidelines
Hrčak ID:
209065
URI
Publication date:
18.11.2018.
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