Case reportAvoiding adverse outcomes in patients with obstructive sleep apnea (OSA): development and implementation of a perioperative OSA protocol☆
Introduction
Obstructive sleep apnea (OSA) is associated with major adverse health outcomes that can be exacerbated in the postoperative setting [1], [2], [3], [4]. In response to reports of adverse postoperative outcomes, various organizations have suggested that hospitals develop specific perioperative management protocols for OSA to improve patient safety [5], [6]. Three cases highlighting perioperative management issues occurring prior to and after implementation of an OSA protocol at our institution are presented. The first case documents an adverse outcome, the second represents a near miss, while the third illustrates the benefit of utilizing an OSA protocol.
Section snippets
Case 1 (prior to an OSA management protocol)
A 45 year-old man fell at home, sustaining a right tibial fracture. Past medical history was significant for obesity [body mass index (BMI) = 41 kg/m2] and a recent diagnosis of OSA, for which he had not been treated.
The patient underwent repair of his tibial fracture with general endotracheal anesthesia. Following extubation, the patient arrived in the Postanesthesia Care Unit (PACU) with oxygen saturation (SpO2) of 80%. The SpO2 improved to 98% after application of a non-rebreathing mask. The
Discussion
Obstructive sleep apnea is a medical condition characterized by recurrent complete (apnea) or partial (hypopnea) upper airway obstruction despite respiratory effort during periods of sleep. Arousals from sleep temporarily restore upper airway patency, only to be followed by a repetitive cycle of airway collapse and arousal [7]. Epidemiologic studies suggest a prevalence of about 5% in the adult population, with the majority of cases being undiagnosed [8], [9]. As such, perioperative care
Conclusion
The number of patients with OSA is increasing. These patients will inevitably require surgery or IV sedation to facilitate diagnostic and therapeutic procedures. Anesthesiologists' experience in managing airway obstruction, expertise in utilization of regional anesthesia techniques, and familiarity with potent, short-acting sedative and analgesic agents, render them particularly well-equipped to develop anesthetic and sedation plans and serve as leaders during the perioperative period for these
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Financial support was provided by the Department of Anesthesia, MetroHealth Medical Center. Institutional support was provided by MetroHealth Medical Center, Cleveland, OH.