Pulse-ox paradox: potential versus pitfalls of pulse oximetry monitoring in surgical patients with obstructive sleep apnea

Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research

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Abstract OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (...
Source: The Annals of Otology, Rhinology, and Laryngology - Category: ENT & OMF Authors: Tags: Ann Otol Rhinol Laryngol Source Type: research
Publication date: Available online 6 December 2019Source: Trends in Anaesthesia and Critical CareAuthor(s): Amr Elkouny, Mohamed Al-Harbi, Vassilios Dimitirou, Ali Muzafar, Ali Nawaz, Amel FayedAbstractBackgroundObstructive Sleep Apnea (OSA) is a serious condition that is usually undiagnosed in surgical patients exposing them to complications such as difficult intubation.ObjectivesTo evaluate the updated STOP-Bang in detecting OSA risk and its perioperative implications.MethodsPreoperative assessment for OSA risk of 845 adult patients using the updated STOP-Bang questionnaire was conducted. Evaluation of anesthetic events ...
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research
Abstract Obstructive sleep apnea (OSA) has a prevalence of up to 5% in children and 50% in obese children. OSA is associated with various comorbidities in the general population and in the perioperative period. In this review, we will provide background of OSA and insights into the available treatment options both surgically and medically. Unlike adults, most pediatric OSA are treated with adenotonsillectomy. Continuous positive airway pressure therapy is the commonly used medical treatment. Management of pediatric OSA is multidisciplinary. We will discuss the surgical options and medical options of managing pedia...
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
Publication date: Available online 23 November 2019Source: American Journal of OtolaryngologyAuthor(s): Michael Eggerstedt, Matthew J. Urban, Emily Chi, Ethan M. Ritz, Phillip LosavioAbstractPurposeDrug-induced sleep endoscopy (DISE) is a cost-effective, safe, and reliable tool to evaluate obstructive sleep apnea (OSA) patients by revealing upper airway sites, patterns, and severity of obstruction. DISE provides valuable data because reliable evaluation of the OSA airway while awake has remained elusive. Few studies (with mixed results) have analyzed the correlation between pre-operation, awake airway assessments routinely...
Source: American Journal of Otolaryngology - Category: Endocrinology Source Type: research
CONCLUSIONS: We found that a number of airway and nonairway parameters were identified with moderate to good correlation with OSA diagnosis in the general population. In future studies, it remains to be seen whether PoCUS screening for a combination of these parameters can address the pitfalls of OSA screening questionnaires. PMID: 31743189 [PubMed - in process]
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Background: Obstructive sleep apnea (OSA), characterized by events of hypoxia-reoxygenation, is highly prevalent in pregnancy, negatively affecting the gestation process and particularly the fetus. Whether the consequences of OSA on the fetus and offspring are mainly caused by systemic alterations in the mother or by direct effect of intermittent hypoxia in the fetus is unknown. In fact, how apnea-induced hypoxemic swings in OSA are transmitted across the placenta remains to be investigated.Aim: To test the hypothesis, based on a theoretical background on the dampening effect of oxygen transfer in the placenta, that oxygen...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sleep and control of breathing Source Type: research
CONCLUSION: Our study showed that a post-induction fentanyl test had good predictive value in identifying severe obstructive sleep apnea syndrome and early postoperative adverse respiratory events, and could provide a reference for postoperative analgesia in children undergoing adenotonsillectomy. PMID: 31742846 [PubMed - as supplied by publisher]
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
A 40-year-old man was treated with tonsillectomy and underwent early surgical exploration because of bleeding. Postoperative bleeding complications were treated with bronchoscopy. In addition to obesity, normal thyroid function, type 2 diabetes mellitus, and current tobacco abuse with severe obstructive sleep apnea syndrome, biochemistry revealed severe hypercholesterolemia (total cholesterol 572 mg/dL) and hypertriglyceridemia (1,220 mg/dL). During the postoperative period, low doses of propofol (up to 2 mg/kg/h for 10 hours), along with remifentanil (up to 0.0016 mg/kg/h for 20 hours), midazolam, and tramadol, were neede...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Letter to the Editor Source Type: research
A 72-year-old, 94-kg, 173-cm man with hypertension, diabetes mellitus, obstructive sleep apnea, and a family history of coronary artery disease presented to the authors ’ preoperative evaluation clinic before an elective carpal tunnel release. An electrocardiogram obtained in the clinic showed previously undocumented atrial flutter. The hand surgery was postponed; the patient was referred to the electrophysiology service for further evaluation. He subsequently un derwent a radiofrequency ablation, but then developed recurrent paroxysmal atrial fibrillation after the procedure.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Diagnostic Dilemma Source Type: research
Purpose of review Ambulatory surgery is the standard for the majority of pediatric surgery in 2019 and adenotonsillectomy is the second most common ambulatory surgery in children so it is an apt paradigm. Preparing and managing these children as ambulatory patients requires a thorough understanding of the current literature. Recent findings The criteria for undertaking pediatric adenotonsillectomy on an ambulatory basis, fasting after clear fluids, postoperative nausea and vomiting (PONV), perioperative pain management and discharge criteria comprise the themes addressed in this review. Summary Three criteria deter...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research
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