Perioperative incidence of airway obstructive and hypoxemic events in patients with confirmed or suspected sleep apnea - a prospective, randomized pilot study comparing propofol/remifentanil and sevoflurane/remifentanil anesthesia.

BACKGROUND

Obstructive sleep apnea (OSA) is a risk factor for perioperative complications but data on anesthesia regimen are scarce.

METHODS

In patients with established or strongly suspected OSA, we assessed in a prospective, randomized design the effects on nocturnal apnea-hypopnea-index (AHI) and oxygen saturation (SpO) of propofol/remifentanil or sevoflurane/remifentanil based anesthesia. Patients were selected by a history for OSA and / or a positive STOP - questionnaire and received general anesthesia using remifentanil (12 μg/kg/h) combined either with propofol (4-6 mg/kg/h, n = 27) or sevoflurane (approx. 2.2 vol% endtidal, n = 27). AHI and SpO were measured during the nights before and after anesthesia.

RESULTS

There were no differences in AHI between anesthetic regimens nor between the pre- and postoperative nights (propofol: 8.6 h (median, CI: 3.6-21.9) vs. 7.9 h (1.8-28.8); p = 0.97; sevoflurane: 3.8 h (1.8-7.3) vs. 2.9 h (1.2-9.5); p = 0.85). Postoperative minimum SpO (propofol: 80.7% ± 4.6, sevoflurane: 81.6 ± 4.6) did not differ from their respective preoperative baselines (propofol: 79.6% ± 6.5; p = 0.26, sevoflurane: 80.8% ± 5.2; p = 0.39). Even in patients with a preanesthetic AHI > 15, nocturnal AHI remained unchanged postoperatively.

CONCLUSION

Thus, in a cohort of patients with suspected or confirmed OSA undergoing surgery of moderate duration and severity neither the volatile agent sevoflurane nor the intravenous anesthetic propofol altered nocturnal AHI or oxygen saturation, when combined with the short acting opioid remifentanil.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00005824 retrospectively registered on 03/12/2014.