Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA.
Curr Opin Anaesthesiol. 2019 Oct;32(5):683-689. doi: 10.1097/ACO.0000000000000778.
In several guidelines, regional anesthesia and analgesia have been suggested as safer alternatives for general anesthesia and systemic analgesia for their safety profile in patients suffering from obstructive sleep apnea (OSA). However, the underlying scientific basis is still evolving. The present review is intended to provide an up-to-date account on the question whether the use of regional anesthesia improves outcomes in patients with OSA.
A number of studies found favorable effects of regional anesthesia used in patients with OSA, including reduced incidence of major perioperative complications such as the need for mechanical ventilation, reintubation and pulmonary/cardiac complications. No negative effects of regional anesthesia specific to patients with OSA were found. Regional anesthesia was most effective when used as a sole technique, but also carried benefits when added to general anesthesia. The majority of available literature focuses on orthopedic surgery and neuraxial anesthesia.
Regional anesthesia can be recommended as a good strategy to treat patients with OSA whenever feasible, as it reduces the incidence of potentially catastrophic perioperative complications. However, the breadth of both surgical and regional anesthetic techniques analyzed is limited; further research should focus on extending the knowledge base beyond neuraxial anesthesia and orthopedics.
在一些指南中，区域麻醉和镇痛因其在患有阻塞性睡眠呼吸暂停（OSA）患者中的安全性而被推荐作为全身麻醉和全身镇痛的更安全替代方法。然而，其潜在的科学基础仍在不断发展。本综述旨在提供关于区域麻醉是否能改善 OSA 患者结局的最新信息。
许多研究发现，在 OSA 患者中使用区域麻醉有有利影响，包括降低主要围手术期并发症的发生率，如需要机械通气、再次插管以及肺/心脏并发症。未发现区域麻醉对 OSA 患者有特定的负面影响。区域麻醉作为单一技术使用时最有效，但与全身麻醉联合使用也有获益。大多数可用的文献都集中在骨科手术和椎管内麻醉上。
只要可行，区域麻醉可作为治疗 OSA 患者的一种很好的策略，因为它可降低潜在灾难性围手术期并发症的发生率。然而，分析的手术和区域麻醉技术的范围有限；进一步的研究应侧重于将知识基础扩展到椎管内麻醉和骨科以外的领域。
