Connolly L A
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226.
J Clin Anesth. 1991 Nov-Dec;3(6):461-9. doi: 10.1016/0952-8180(91)90094-4.
Presented in an illustrative case report and a review of the anesthetic management of obstructive sleep apnea patients. Preoperative evaluation should include a thorough airway evaluation and a comprehensive cardiovascular and pulmonary evaluation. With polysomnography, identification of the severity of sleep apnea can be idenified. Although sleep centers vary in their definitions, severe obstructive sleep apnea is diagnosed if the patient demonstrates an apnea index greater than 70 and an oxygen (O2) desaturation less than 80% with cardiovascular sequelae. Severe sleep apnea patients are at extreme risk for general anesthesia. These risks should be discussed preoperatively with the patient. Unsupervised preoperative sedation should be avoided because of the extreme sensitivity of these patients to sedatives and airway obstruction. Intraoperative management of the obstructive sleep apnea patient varies depending on the severity of the sleep apnea. Invasive monitoring may be necessary if the patient demonstrates evidence of cardiopulmonary dysfunction. With the assistance of the otolaryngologist, the anesthesiologist can formulate an approach to establishing an airway. Intraoperative opioids and sedatives should be limited. The recovery of the sleep apnea patient is extremely important and is the time when most airway emergencies occur. Extubation of the patient should occur when appropriate surgical personnel and equipment are available in case of an airway emergency. Steroids may be used to decrease the amount of airway swelling. Supplemental O2 should be used in patients who demonstrate desaturation. Opioids and sedatives should be avoided, as should other drugs that have central and sedating effects. Postoperative pain is effectively controlled with acetaminophen and topical anesthetic sprays. Postoperative monitoring for apnea, desaturation, and dysrhythmias is a necessity in sleep apnea patients.
本文通过一个病例报告及对阻塞性睡眠呼吸暂停患者麻醉管理的综述进行阐述。术前评估应包括全面的气道评估以及综合的心血管和肺部评估。通过多导睡眠图，可以确定睡眠呼吸暂停的严重程度。尽管各睡眠中心的定义有所不同，但如果患者的呼吸暂停指数大于70，且伴有心血管后遗症的氧（O2）饱和度低于80%，则可诊断为重度阻塞性睡眠呼吸暂停。重度睡眠呼吸暂停患者接受全身麻醉时风险极高。术前应与患者讨论这些风险。由于这些患者对镇静剂和气道梗阻极为敏感，应避免术前无监督的镇静。阻塞性睡眠呼吸暂停患者的术中管理因睡眠呼吸暂停的严重程度而异。如果患者有心肺功能障碍的证据，可能需要进行有创监测。在耳鼻喉科医生的协助下，麻醉医生可以制定建立气道的方法。术中应限制使用阿片类药物和镇静剂。睡眠呼吸暂停患者的恢复极为重要，且此时最易发生气道紧急情况。当有适当的手术人员和设备可应对气道紧急情况时，应进行患者拔管。可使用类固醇来减轻气道肿胀程度。对出现饱和度降低的患者应使用补充氧气。应避免使用阿片类药物和镇静剂，以及其他具有中枢和镇静作用的药物。对乙酰氨基酚和局部麻醉喷雾剂可有效控制术后疼痛。睡眠呼吸暂停患者术后必须监测呼吸暂停、饱和度降低和心律失常情况。
