gms | German Medical Science

Perioperative care includes pre-, intra-, and postoperative management.

There is enough evidence to proof that obstructive sleep apnea (OSA) patients in general have an increased perioperative risk. Treatment of OSA improves comorbidities and reduces perioperative risk. However, most patients have not been diagnosed prior to surgery. Sleep studies are time-consuming and costly. To handle this problem short questionnaires (ASA, STOP-BANG, Berlin) are recommended to screen for OSA preoperatively.

If sleep surgery is performed in patients with OSA physicians need to expect a difficult intubation and difficulties after extubation. Intraoperative recommendations include abstinence of sedative drugs, use of local and regional anaesthesia whenever possible, use of short-lasting agents for anesthesia, sedation, and pain-control, invasive monitoring, and extubation not before patient is completely awake.

Patients with OSA shows an increased number postoperative complications. Postoperative care needs to address these issues, but how intense and how long needs a special postoperative care to be? A meta-analysis of the literature up to the year 2013 detected 7 papers focussing on the perioperative risk after multi-level surgery for OSA. All papers detected an increased periopertive risk. However complications always occurred within the first 2–4 hours after extubation. In other words beyond 4 hours not a single severe complication has been recorded. Our own data confirm these findings. Supervision within the recovery room for 4 hours seems to be sufficient to detect those candidates after OSA surgery that need further monitoring.