Jain Sanjay S, Dhand Rajiv
Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri-Columbia and Harry S. Truman VA Hospital, Columbia, Missouri 65212, USA.
Curr Opin Pulm Med. 2004 Nov;10(6):482-8. doi: 10.1097/01.mcp.0000143968.41702.f0.
Obstructive sleep apnea is a common disorder. Despite reports of its role as a risk factor for postoperative morbidity and mortality, only a few investigators have examined the optimal treatment of patients during this vulnerable period. Recognition of obstructive sleep apnea during conscious sedation or in the perioperative period is important to prevent the occurrence of adverse outcomes. This review discusses the influence of sedative, anesthetic, and analgesic agents and other factors during the perioperative period on patients with obstructive sleep apnea. The aim of this article is to emphasize the importance of recognizing and appropriately treating surgical patients with obstructive sleep apnea.
Sedative, analgesic, and anesthetic agents used perioperatively play a major role in the development of sleep-disordered breathing during the postoperative period. Postoperative apneic episodes frequently occur even after surgery remote from the upper airway. Sleep apnea predisposes patients to a greater than normal risk for postsurgical complications. Adequate screening of patients preoperatively and initiation of continuous positive airway pressure therapy perioperatively could prevent serious complications, including hypoxemia, arrhythmias, myocardial infarction, and respiratory arrest.
Obstructive sleep apnea places a significant proportion of surgical patients at increased risk of perioperative complications. Obstructive sleep apnea can be induced, unmasked, or exacerbated by the effects of sedative, analgesic, and anesthetic agents regardless of the site of surgery. The role of sleep apnea as a risk factor for development of postoperative complications needs greater emphasis. Increased awareness of the risk posed by an obstructed upper airway and appropriate management are important to optimize the perioperative care of patients with obstructive sleep apnea.
阻塞性睡眠呼吸暂停是一种常见疾病。尽管有报道称其为术后发病和死亡的危险因素，但仅有少数研究者探讨了在此脆弱时期对患者的最佳治疗方法。在清醒镇静或围手术期识别阻塞性睡眠呼吸暂停对于预防不良后果的发生很重要。本综述讨论了围手术期镇静剂、麻醉剂、镇痛药及其他因素对阻塞性睡眠呼吸暂停患者的影响。本文旨在强调识别并适当治疗阻塞性睡眠呼吸暂停手术患者的重要性。
围手术期使用的镇静剂、镇痛药和麻醉剂在术后睡眠呼吸紊乱的发生中起主要作用。即使在上气道较远部位手术后，术后呼吸暂停发作也经常发生。睡眠呼吸暂停使患者术后并发症风险高于正常水平。术前对患者进行充分筛查并在围手术期开始持续气道正压通气治疗可预防严重并发症，包括低氧血症、心律失常、心肌梗死和呼吸骤停。
阻塞性睡眠呼吸暂停使相当一部分手术患者围手术期并发症风险增加。无论手术部位如何，镇静剂、镇痛药和麻醉剂的作用都可能诱发、暴露或加重阻塞性睡眠呼吸暂停。睡眠呼吸暂停作为术后并发症发生危险因素的作用需要更加强调。提高对上气道阻塞所带来风险的认识并进行适当管理对于优化阻塞性睡眠呼吸暂停患者的围手术期护理很重要。
