Phoenix Health, Ruthin, United Kingdom.
Surg Obes Relat Dis. 2013 Nov-Dec;9(6):845-9. doi: 10.1016/j.soard.2012.09.006. Epub 2012 Sep 29.
In the United Kingdom, demand for intensive care beds (level 3 critical care) often outstrips supply, leading to frequent and frustrating cancellation of complex elective surgery. It has been suggested that patients with obstructive sleep apnea who undergo bariatric surgery should be admitted to a level 3 facility for routine postoperative management. We have questioned the validity of this dogma in the era of laparoscopic bariatric surgery by using a simple easily applicable algorithm.
The aim of this study was to investigate the clinical outcome of patients with obstructive sleep apnea (OSA) without admission to the intensive care unit after laparoscopic bariatric surgery.
For the first 24 hours after surgery, all patients were admitted to a level 2 (high-dependency) area on a general surgical ward with experience of bariatric surgery. They received supplemental oxygen, continuous pulse oximetry, and judicious analgesic administration using a combination of small boluses of i.v. morphine together with i.v. paracetamol. Perioperative continuous positive airway pressure support was not routinely given, unless patients with OSA had oxygen saturation below their recorded preoperative level on 2 consecutive readings.
A total of 1623 patients underwent laparoscopic bariatric surgery over a 12-year period. Of those, 192 had OSA with a median operative body mass index of 52 kg/m(2) (range 34-78 kg/m(2)). The incidence of respiratory complications and the median length of stay (3 nights) were identical in patients with OSA and those without OSA. Four patients self-administered perioperative continuous positive airway pressure, but none required transfer to intensive care or mechanical ventilation. There were no in-hospital deaths.
Laparoscopic bariatric surgery in patients with OSA is well tolerated and does not require the routine use of level 3 critical care facilities.
在英国，重症监护病床（3 级重症监护）的需求经常超过供应，导致经常令人沮丧地取消复杂的择期手术。有人建议，接受减肥手术的阻塞性睡眠呼吸暂停患者应被收入 3 级设施进行常规术后管理。我们通过使用简单易用的算法对腹腔镜减肥手术时代的这一教条提出了质疑。
本研究旨在调查阻塞性睡眠呼吸暂停（OSA）患者在接受腹腔镜减肥手术后无需入住重症监护病房的临床结果。
手术后的头 24 小时，所有患者均被收入普通外科病房的 2 级（高依赖）病房，该病房有减肥手术经验。他们接受补充氧气、连续脉搏血氧饱和度监测以及静脉注射吗啡小剂量联合静脉注射扑热息痛的合理镇痛管理。除非 OSA 患者的氧饱和度连续两次读数低于术前记录水平，否则不会常规给予围手术期持续气道正压通气支持。
在 12 年期间，共有 1623 例患者接受了腹腔镜减肥手术。其中，192 例患有 OSA，其平均手术体重指数为 52 kg/m²（范围 34-78 kg/m²）。OSA 患者和无 OSA 患者的呼吸并发症发生率和中位住院时间（3 晚）相同。有 4 名患者自行进行了围手术期持续气道正压通气，但均无需转入重症监护或机械通气。无院内死亡。
腹腔镜减肥手术治疗 OSA 患者耐受性良好，不需要常规使用 3 级重症监护设施。
