Rennotte M T, Baele P, Aubert G, Rodenstein D O
Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Chest. 1995 Feb;107(2):367-74. doi: 10.1378/chest.107.2.367.
Anesthetic, sedative, and analgesic drugs have been shown in animals and humans to selectively impair upper airway muscle activity. In patients with an already compromised upper airway, these drugs may further jeopardize upper airway patency, especially during sleep. Thus, patients with obstructive sleep apnea syndrome (OSAS) are at high risk for surgery because of the use of the aforementioned drugs in the perioperative period. It has been recommended that such drugs should be avoided or used with extreme caution in patients with OSAS submitted to surgery. We report herein on 16 adult patients with documented OSAS undergoing various types of surgical procedures, including coronary artery bypass surgery. Anesthesia was carried on with the usual type of drugs for each type of surgery. Postoperative opioid analgesia and sedation were not restricted. The first patient, whose OSAS was diagnosed but not treated, died after various complications, including a respiratory arrest in the ward. The second patient experienced serious postoperative complications until a treatment for OSAS with nasal continuous positive airway pressure (N-CPAP) was instituted, and thereafter he made an uneventful recovery. The 14 following patients were started on N-CPAP before surgery, were put on N-CPAP as soon as extubated, on a near-continuous basis, for 24 to 48 h and thereafter for all sleep periods. None of them had major complications. The intensive care unit and hospital stays were the normal ones for each type of surgery in our institution. We conclude that N-CPAP started before surgery and resumed immediately after extubation allowed us to safely manage a variety of surgical procedures in patients with OSAS, and to freely use sedative, analgesic, and anesthetic drugs without major complications. Every effort should be made to identify patients with OSAS and institute N-CPAP therapy before surgery.
麻醉药、镇静药和镇痛药已在动物和人类身上显示出会选择性地损害上呼吸道肌肉活动。在已经存在上呼吸道功能受损的患者中，这些药物可能会进一步危及上呼吸道通畅，尤其是在睡眠期间。因此，阻塞性睡眠呼吸暂停综合征（OSAS）患者在围手术期因使用上述药物而面临高手术风险。建议在接受手术的OSAS患者中避免使用此类药物或极其谨慎地使用。我们在此报告16例有记录的OSAS成年患者接受各种外科手术，包括冠状动脉搭桥手术。每种手术均采用常规类型的药物进行麻醉。术后阿片类镇痛和镇静不受限制。第一名患者OSAS已被诊断但未接受治疗，在出现各种并发症（包括在病房发生呼吸骤停）后死亡。第二名患者术后出现严重并发症，直到开始使用鼻持续气道正压通气（N-CPAP）治疗OSAS，此后他顺利康复。接下来的14名患者在手术前开始使用N-CPAP，拔管后立即几乎持续使用N-CPAP 24至48小时，此后在所有睡眠期间使用。他们均未出现重大并发症。重症监护病房和住院时间为我们机构每种手术的正常时间。我们得出结论，术前开始并在拔管后立即恢复使用N-CPAP使我们能够安全地处理OSAS患者的各种外科手术，并自由使用镇静药、镇痛药和麻醉药而无重大并发症。应尽一切努力识别OSAS患者并在手术前开始N-CPAP治疗。
