Kaw Roop, Wong Jean, Mokhlesi Babak
From the Departments of Hospital Medicine and Outcomes Research, Anesthesiology, Cleveland Clinic, Cleveland, Ohio.
Department of Anesthesiology and Pain Medicine, Toronto Western Hospital.
Anesth Analg. 2021 May 1;132(5):1265-1273. doi: 10.1213/ANE.0000000000005352.
Obesity hypoventilation syndrome (OHS) is considered as a diagnosis in obese patients (body mass index [BMI] ≥30 kg/m2) who also have sleep-disordered breathing and awake diurnal hypercapnia in the absence of other causes of hypoventilation. Patients with OHS have a higher burden of medical comorbidities as compared to those with obstructive sleep apnea (OSA). This places patients with OHS at higher risk for adverse postoperative events. Obese patients and those with OSA undergoing elective noncardiac surgery are not routinely screened for OHS. Screening for OHS would require additional preoperative evaluation of morbidly obese patients with severe OSA and suspicion of hypoventilation or resting hypoxemia. Cautious selection of the type of anesthesia, use of apneic oxygenation with high-flow nasal cannula during laryngoscopy, better monitoring in the postanesthesia care unit (PACU) can help minimize adverse perioperative events. Among other risk-reduction strategies are proper patient positioning, especially during intubation and extubation, multimodal analgesia, and cautious use of postoperative supplemental oxygen.
肥胖低通气综合征（OHS）被视为肥胖患者（体重指数[BMI]≥30kg/m²）的一种诊断，这些患者同时存在睡眠呼吸紊乱和清醒时日间高碳酸血症，且无其他低通气原因。与阻塞性睡眠呼吸暂停（OSA）患者相比，OHS患者的合并症负担更高。这使OHS患者术后发生不良事件的风险更高。肥胖患者和接受择期非心脏手术的OSA患者通常不常规筛查OHS。筛查OHS需要对患有严重OSA且怀疑存在低通气或静息性低氧血症的病态肥胖患者进行额外的术前评估。谨慎选择麻醉类型、在喉镜检查期间使用高流量鼻导管进行无呼吸氧合、在麻醉后护理单元（PACU）进行更好的监测，有助于将围手术期不良事件降至最低。其他降低风险的策略包括正确的患者体位，尤其是在插管和拔管期间、多模式镇痛以及谨慎使用术后补充氧气。
