As the population in the United States becomes more obese every year, the incidence of obstructive sleep apnea hypopnea syndrome is also increasing. In the general population, the incidence of obstructive sleep apnea is 2% in women and 4% in men. The airway obstruction in obstructive sleep apnea patients is due to a decrease in the upper airway muscle tone during sleep and airway narrowing due to the deposition of adipose tissue in pharyngeal structures. The structures that may increase in size due to deposition of fat are the uvula, tonsils, tonsillar pillars, tongue, aryepiglottic folds and the lateral pharyngeal walls.
A careful review of all medical records is very important. The preoperative diagnosis, exact surgical procedure being performed and proper consent for anesthesia and surgery should be noted. Reviewing old medical records can be particularly useful with regard to previous anesthetic history, which may reveal airway difficulties, an unusual response to anesthetic agents and the postoperative course. All co-existing medical conditions and treatments should be noted. In addition to the routine laboratory values, any work-up that has been done specific to obstructive sleep apnea hypopnea syndrome such as polysomnographic testing, cephalometric measurements, cardiac or pulmonary function studies should be checked. All consultations should be reviewed and if a specific question arises, the consultant in question should be contacted. A detailed history from the patient and bedpartner if possible should identify patients with undiagnosed obstructive sleep apnea hypopnea syndrome.
Because of the increased incidence of aspiration of gastric contents, an antacid and metoclopramide should be given to decrease the gastric acidity and volume. Glycopyrrolate to reduce oral secretions and dexametasone to reduce airway edema and nausea and vomiting are generally administered. Obese patients have increased oxygen consumption and decreased lung volumes. Functional residual capacity and expiratory reserve volume are small and patients become desaturated faster during apnea.
Airway edema is a major concern for patients undergoing surgical repair for obstructive sleep apnea. Small airways compounded with surgical trauma or a difficult intubation put obstructive sleep apnea patients at a higher risk for airway compromise. It is of paramount importance for both the anesthesiologist and the surgeon to make all attempts at reducing airway edema in patients undergoing obstructive sleep apnea surgery. Preoperative and postoperative intravenous steroids have routinely been shown to be effective in the reduction of airway edema.
Adequate blood pressure control is very important in the management of a postoperative obstructive sleep apnea patient. Hypertension is more commonly seen in obstructive sleep apnea patients secondary to their heightened sympathetic drive. Consequently, elevated blood pressure leads to more bleeding and increased tissue swelling. Although induced hypotension is not currently used for obstructive sleep apnea surgeries, the patient's blood pressure should be managed prior to the procedure and controlled throughout the perioperative period.
In addition, it is important to remember the sedatives and narcotics used throughout the case, because of their lingering analgesic and depressant effects on the patient. Unfortunately, the spectrum of pharmaceutical options for analgesia ranges from minimal pain relief with a low incidence of side effects, to good pain relief with a higher incidence of side effects. Non-steroidal anti-inflammatory drugs are usually inadequate for postoperative pain control and standard narcotic dosing or patient-controlled analgesic infusions put the patient at increased risk of obstructive complications. One regimen found to be effective involves lower dosed intravenous narcotics for immediate pain control and oral hydrocodone or acetaminophen with codeine once the patient resumes eating.
A wide variety of therapies have been described to treat sleep disordered breathing. These range from modifying predisposing conditions, reducing medical risk factors such as obesity, appliances in the form of oral, nasal, CPAP(continuous positive airway pressure) machine, and finally upper airway surgeries. These wide variety of techniques makes assessment of effectiveness difficult when it comes to finding an absolute cure for snoring. If you are interested to learn more about how to stop snoring naturally take advantage of this buy one get one free offer.
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