SAFETY OF MULTI-LEVEL SURGERY IN OBSTRUCTIVE SLEEP APNES

Sleep-related respiratory disorders (USB); It can be defined as a spectrum of diseases consisting of snoring, upper airway resistance syndrome and obstructive sleep apnea (OSA). It is reported that SDB is seen at a rate of 24% in men and 9% in women. It is known that most USB patients are not diagnosed. 93% of female and 82% of male patients with moderate-severe OSA were undiagnosed. It is well documented that TUA has serious effects on the cardiovascular and respiratory systems and on neurocognitive functions. It has been shown that there is a strong relationship between SDB and hypertension. This is thought to be due to sleep disruption, nocturnal hypoxemia (low oxygen level in the blood), and increased sympathetic tone.

OSA patients have a high risk of encountering airway problems when they undergo surgery. The reason for this is expressed as that these cases are difficult for the anesthesiologist due to the small mandible, large tongue, and short and thick neck structures. In addition, TUA cases are very sensitive to muscle relaxants and narcotic analgesics. Respiratory depression and recurrent apneas may occur upon awakening from anesthesia. After the use of narcotic analgesics, respiratory depression lasting 4-12 hours may occur. Laryngeal edema was reported as 5.7% in some series. This situation can be overcome with the use of prophylactic steroids.

Patients with an apnea index (AI) greater than 70 and a trough oxygen concentration of less than 80% are at higher risk for postoperative complications, especially oxygen saturation decreases.

In a study evaluating 1698 surgical procedures performed on 487 patients, the overall complication rate was found to be 7.1%. The breakdown of complications is as follows:

  • Bleeding problems (3.1%): Postoperative 7-15. developed between days. Eight of the 15 patients had to be taken to the operating room. None of them required blood transfusion. It was determined that one of the cases used gingko biloba and one of them used aspirin.
  • Persistent hypertension (3.1%): All of these patients have preoperative hypertension.
  • Swelling of the tongue (1.8%): It was caused by tongue sling sutures in all cases.
  • Decrease in oxygen saturation (1.2%): It occurred in the first 180 minutes postoperatively in all patients.
  • Pulmonary edema due to negative pressure (0.4%): It is due to biting the tube during inspiration while awakening from anesthesia. Intravascular fluid is drawn into the alveoli.
  • Airway obstruction (0.2%): It developed after bleeding that started on the floor of the mouth after heavy coughing on the 2nd postoperative day in a case where only one nose, palate and tongue surgery was performed. He was urgently intubated nasoendotracheally and remained intubated under sedation for 3 days.
  • Nasopharyngeal stenosis: It was not seen in any case.

All OSA cases should be kept under intensive surveillance for at least 3 hours after surgery. The use of perioperative CPAP (continuous positive airway pressure) is recommended to reduce postoperative respiratory problems. The first group of patients in this study were cases where nose and palate surgery was performed in a single session. This group of patients was kept in the hospital for at least 6 hours after surgery. The second group of patients were subject to nose, palate and tongue surgery and were followed up in the hospital for at least one night.

The full article is available at the link below (Pang KP, et al. Arch Otolaryngol Head Neck Surg 2012;138:353-7).

SURGERY SAFETY

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