Obstructive Sleep ApneaObstructive sleep apnea (OSA) may influence the choices made by an anesthesiologist when planning your anesthetic. Northeastern Anesthesia Services (NEA) doctors employ expertise gained at leading training programs (e.g. New York Presbyterian Hospital, Dartmouth Hitchcock Medical Center, Mount Sinai Hospital, New York University, Yale University) to provide the highest standard of care to patients suffering from Obstructive sleep apnea (OSA).
What is Obstructive Sleep Apnea (OSA)?
Obstructive sleep apnea (OSA) is a common sleep disorder that can have important implications for the anesthesiologist when planning your anesthetic. This syndrome is characterized by repetitive partial or complete obstruction of the upper airway during sleep. Normally, there is a balance between the forces that cause the upper airway to collapse and muscles that keep it open. When OSA is present, an imbalance in these forces can cause the cessation of breathing for up to ten seconds.
OSA is quite common, occurring in 12% of men and 5% of women. Patients who snore, smoke, are overweight, or have hypertension or heart disease are at significant risk for this disease.
There is some evidence that establishing a diagnosis (by doing a sleep study) and initiating treatment (using continuous positive airway pressure [CPAP] masks) may improve the perioperative outcomes of patients at risk for OSA. However, the disorder is so common that it is not realistic at this time to try to test and treat all patients at risk. The anesthesia service has developed criteria that help assess your risk for sleep apnea and assist in the planning of your anesthetic.
How Does Obstructive Sleep Apnea (OSA) Impact Anesthetic Choices?
Many factors that increase the risk of OSA also increase the difficulty of managing your airway and breathing. Heavy patients with large neck circumferences sometimes present more difficult airway management challenges. Expert care of a difficult airway is critical both at the onset of anesthesia as well as at the end of your surgery.
How Do Anesthesia Specialists Conduct a Safe Anesthetic for Patients with Obstructive Sleep Apnea (OSA)?
Anesthetic agents typically administered during a general anesthetic all impair respiratory function and increase the risk for the airway to obstruct. These drugs, by relaxing the muscles that keep the airway open, simulate the airway obstruction that occurs at night in OSA patients. For this reason eticulous attention is devoted to airway management and ventilation during the entire perioperative period. When possible, regional anesthetic techniques ( such as nerve blocks or spinal anesthesia) in combination with mild sedation, may be the favored anesthetic technique for certain procedures. The use of pain medications in the post-operative period also can lead to an increased risk of obstruction.
Narcotics must be used judiciously and can be administered in combination with medications such as Toradol (an NSAID) to reduce airway complications. In patients with OSA, it is important to monitor breathing and oxygen levels in the postoperative period. Patients who use CPAP machines at night should bring them to the hospital to be used in the recovery period. In some instances, it may be necessary to delay a patient’s discharge until the patient’s safety can be assured. Stringent criteria developed by our staff must be met prior to the patient’s discharge from the recovery area.
OSA predisposes patients to a number of medical conditions. These include hypertension, cardiovascular disease, heart failure, stroke, diabetes, and auto accidents. Clearly OSA has important implications for the lives of those affected, both as related to surgery and anesthesia, as well as their general health. Your NEA anesthesiologist is well trained to address this condition and plan a safe anesthetic for you.