Ravesloot Madeline J L, de Raaff Christel A L, van de Beek Megan J, Benoist Linda B L, Beyers Jolien, Corso Ruggero M, Edenharter Günther, den Haan Chantal, Heydari Azad Jacqueline, Ho Jean-Pierre T F, Hofauer Benedkt, Kezirian Eric J, van Maanen J Peter, Maes Sabine, Mulier Jan P, Randerath Winfried, Vanderveken Olivier M, Verbraecken Johan, Vonk Patty E, Weaver Edward M, de Vries Nico
Department of Otorhinolaryngology, OLVG, Amsterdam, the Netherlands.
Department of Otorhinolaryngology, Medical Centre Jan van Goyen, Amsterdam, the Netherlands.
JAMA Otolaryngol Head Neck Surg. 2019 Aug 1;145(8):751-760. doi: 10.1001/jamaoto.2019.1448.
To date, no consensus exists regarding optimal perioperative care of patients with obstructive sleep apnea (OSA) undergoing upper airway (UA) surgery. These patients are at risk related to anesthesia and postoperative analgesia, among other risks associated with difficult airway control, and may require intensified perioperative management.
To provide a consensus-based guideline by reviewing available literature and collecting expert opinion during an international consensus meeting with experts from relevant speciliaties.
In a consensus meeting conducted on April 4, 2018, a total of 47 questions covering preoperative, intraoperative, and postoperative care were formulated by 12 international experts with extensive clinical experience in the field of UA surgery for OSA. Systematic literature searches were performed by an independent information specialist and 6 researchers according to the Oxford and GRADE systems, and 164 articles published on or before December 31, 2011, were included in the analysis. Two moderators chaired the meeting according to the Amsterdam Delphi Method, including iteration of literature conclusions, expert discussion, and voting rounds. Consensus was reached when there was 70% or more agreement among experts.
Of 47 questions, 35 led to a recommendation or statement. The remaining 12 questions provided no additional information and were excluded in the judgment of experts. Consensus was reached for 32 recommendations. For 1 question there was less than 70% agreement among experts; therefore, consensus was not achieved. Highlights of these recommendations include (1) postoperative bleeding is a complication described for all types of UA surgery; (2) OSA is a relative risk factor for difficult mask ventilation and intubation, and plans for difficult airway management should be considered and implemented; (3) safe perioperative care should be provided, with aspects such as OSA severity, adherent use of positive airway pressure, type of surgery, and comorbidities taken into account; (4) although there is no direct evidence to date, in patients undergoing UA surgery, preoperative treatment with positive airway pressure may reduce the risk of postoperative airway complications; and (5) alternative pain management options perioperatively to reduce opioid use should be considered.
This consensus contains 35 recommendations and statements on the perioperative care of patients with OSA undergoing UA surgery and may be used as a guideline in daily practice.
迄今为止，对于接受上气道（UA）手术的阻塞性睡眠呼吸暂停（OSA）患者的最佳围手术期护理尚无共识。这些患者面临与麻醉和术后镇痛相关的风险，以及与困难气道控制相关的其他风险，可能需要强化围手术期管理。
通过回顾现有文献并在与相关专业专家举行的国际共识会议上收集专家意见，提供基于共识的指南。
在2018年4月4日举行的一次共识会议上，12位在OSA的UA手术领域拥有丰富临床经验的国际专家提出了总共47个涵盖术前、术中和术后护理的问题。一名独立信息专家和6名研究人员根据牛津和GRADE系统进行了系统的文献检索，分析纳入了2011年12月31日或之前发表的164篇文章。两名主持人根据阿姆斯特丹德尔菲法主持会议，包括文献结论的迭代、专家讨论和投票轮次。当专家之间达成70%或更高的共识时，即达成共识。
在47个问题中，35个问题得出了建议或声明。其余12个问题未提供额外信息，在专家判断中被排除。32条建议达成了共识。对于1个问题，专家之间的共识不足70%；因此，未达成共识。这些建议的要点包括：（1）术后出血是所有类型UA手术都可能出现的并发症；（2）OSA是面罩通气困难和插管困难的相对危险因素，应考虑并实施困难气道管理计划；（3）应提供安全的围手术期护理，考虑OSA严重程度、持续使用气道正压、手术类型和合并症等方面；（4）尽管迄今为止没有直接证据，但在接受UA手术的患者中，术前使用气道正压治疗可能降低术后气道并发症的风险；（5）应考虑围手术期替代疼痛管理方案以减少阿片类药物的使用。
本共识包含35条关于接受UA手术的OSA患者围手术期护理的建议和声明，可作为日常实践中的指南。
