Unrecognized sleep apnea in the surgical patient - Implications for the perioperative setting
Unrecognized sleep apnea in the surgical patient - Implications for the perioperative setting
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DOI：
10.1378/chest.129.1.198
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发表时间：
2006-01-01
期刊：
影响因子：
9.6
通讯作者：
Golish, J
中科院分区：
文献类型：
--
作者：
Kaw, R;Michota, F;Golish, J
麻醉和手术都会影响睡眠的结构。除了麻醉和手术的术后影响外，睡眠剥夺和碎片已被证明会产生呼吸暂停或去饱和，即使在没有假定睡眠呼吸暂停的患者中也是如此。最近的流行病学数据表明，在西方国家，阻塞性睡眠呼吸暂停综合征（OSAS）的患病率约为5%。由于OSAS患者可能需要进行手术，因此诊断OSAS的困难进一步阻碍了该问题。没有事先诊断。临床怀疑OSAS可能首先在术中被识别。不良的手术结果似乎在OSAS患者中更常见。术后即刻并发症可直观地归因于镇静剂、镇痛剂和麻醉剂的负面作用，其可通过降低咽张力以及对缺氧、听觉亢进和阻塞的唤醒反应而使OSAS恶化。然而，后期事件更可能与术后快速眼动（REM）睡眠反弹有关。在重度OSAS患者中，REM睡眠反弹可能与阿片类药物给药和仰卧位一起加重睡眠呼吸障碍。REM睡眠反弹也被认为有助于精神混乱和术后谵妄、心肌缺血/梗死、中风和伤口破裂。虽然指导中重度OSAS患者围手术期管理的数据很少，但建议提高认识。术前和拔管后选择性使用经鼻持续气道正压通气治疗可能是有益的。学习目标：1.确定围手术期麻醉和手术影响的常见睡眠结构。2.说明阻塞性睡眠呼吸暂停综合征患者围手术期并发症。3.确定最有利于改善阻塞性睡眠呼吸暂停综合征患者护理的围手术期干预和管理技术。
Anesthesia and surgery both affect the architecture of sleep. Aside from the postoperative effects of anesthesia and surgery, sleep deprivation and fragmentation have been shown to produce apneas or desaturations even in patients without presumed sleep apnea. Recent epidemiologic data have placed the prevalence of obstructive sleep apnea syndrome (OSAS) at about 5% among Western countries. The problem is further hindered by the difficulty in diagnosing OSAS, as patients with OSAS may present for surgery. without a prior diagnosis. Clinical suspicion for OSAS may first be recognized intraoperatively. Adverse surgical outcomes appear to be more frequent in OSAS patients. Immediate postoperative complications may intuitively be attributed to the negative effects of sedative, analgesic, and anesthetic agents, which can worsen OSAS by decreasing pharyngeal tone, and the arousal responses to hypoxia, hyperearbia, and obstruction. Later events are, however, more likely to be related to postoperative rapid eye movement (REM) sleep rebound. In the severe OSAS patient, REM sleep rebound could conceivably act in conjunction with opioid administration and supine posture to aggravate sleep-disordered breathing. REM sleep rebound has also been suggested to contribute to mental confusion and postoperative delirium, myocardial ischemia/infarction, stroke, and wound breakdown. Although the data to guide the perioperative management of patients with moderate-to-severe OSAS is scarce, heightened awareness is recommended. The selected use of therapy with nasal continuous positive airway pressure before surgery and after extubation may be beneficial. Learning Objectives: 1. Identify, common sleep architectures affected by anesthesia and surgery in the perioperative period. 2. State a perioperative complication in Obstructive Sleep Apnea Syndrome patients. 3. Identify perioperative interventions and management techniques that best facilitate improved obstructive sleep apnea syndrome patient care.