Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care, Western University, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada.
Department of Anesthesiology, University Health Network, Toronto Western Hospital, 399 Bathurst Street, McL2-405, Toronto, Ontario M5T 2S8, Canada.
Br J Anaesth. 2017 Nov 1;119(5):885-899. doi: 10.1093/bja/aex341.
The care of surgical patients with obstructive sleep apnoea (OSA) invokes concerns with safety and liability because of the risk that exists for perioperative death or near-death. The purpose of this review is to analyse the available literature to identify risk factors for perioperative critical complications in patients with OSA. Literature reports were screened for life threatening complications and deaths in surgical patients with OSA. The critical complications were sub-grouped as death/near-death events (death and anoxic brain damage) vs critical respiratory events (CRE)/other events and analysed for various risk factors. Both univariate and multivariate analyses were conducted to identify the potential risk factors.In total, 15 case reports and two medico-legal reports, comprising of 60 total patients with OSA were included in our analysis. Overall, there were 43 deaths or near-death events and 12 critical respiratory events and five other life threatening events. Ten patients (17%) with OSA were undiagnosed before surgery. Only 31% (11/35) were on preoperative continuous positive airway pressure (CPAP), with 36% (4/11) of them continuing CPAP in the postoperative period. The majority of them received a morphine equivalent daily dose less than 10 mg. Eighty percent of the events occurred in the first 24 h and 67% occurred on the general hospital ward.Patients with OSA are at risk of critical complications including death during the initial 24 h after surgery. Morbid obesity, male sex, undiagnosed OSA, partially treated/untreated OSA, opioids, sedatives, and lack of monitoring are risk factors for death or near-death events.
患有阻塞性睡眠呼吸暂停（OSA）的外科手术患者的护理存在安全和责任问题，因为围手术期存在死亡或濒临死亡的风险。本综述的目的是分析现有文献，以确定 OSA 患者围手术期发生严重并发症的危险因素。筛选了 OSA 外科手术患者发生威胁生命并发症和死亡的文献报告。将严重并发症分为死亡/濒死事件（死亡和缺氧性脑损伤）与严重呼吸事件（CRE）/其他事件，并对各种危险因素进行分析。进行了单因素和多因素分析以确定潜在的危险因素。
总共纳入了 15 例病例报告和 2 例医疗法律报告，共包含 60 例 OSA 患者。总的来说，有 43 例死亡或濒死事件和 12 例严重呼吸事件以及 5 例其他危及生命的事件。10 例（17%）OSA 患者在手术前未被诊断。仅 31%（11/35）患者在术前接受持续气道正压通气（CPAP），其中 36%（4/11）在术后继续接受 CPAP。他们大多数人接受的吗啡等效日剂量低于 10mg。80%的事件发生在手术后 24 小时内，67%的事件发生在综合医院病房。
患有 OSA 的患者在手术后的最初 24 小时内有发生严重并发症（包括死亡）的风险。病态肥胖、男性、未诊断的 OSA、部分治疗/未治疗的 OSA、阿片类药物、镇静剂以及缺乏监测是死亡或濒死事件的危险因素。
