Surgery and Sleep Apnea: Airway, Anesthesia, and Perioperative Considerations

PROGRAM DESCRIPTION: Obstructive sleep apnea is a disease impacting up to 20% of the American population. It is characterized by recurrent episodes of upper airway collapse leading to ventilatory disruption, oxygen desaturation, and sympathetic nervous system activation. It is associated with sleep disruption, daytime fatigue, and numerous cardiovascular comorbidities including hypertension, coronary artery disease, peripheral vascular disease, and cerebrovascular accident.

Positive airway pressure therapy is the typical initial treatment modality employed as it is noninvasive and offers benefit in the quality-of-life symptoms and cardiovascular comorbidities associate with OSA. Unfortunately, the tolerance and usage of PAP therapy is poor leading to many patients going without therapy.

As we better understand the physiologic mechanisms leading to upper airway collapse, develop new treatment options to offer patients with OSA, and improve our patient selection, Otolaryngology is becoming the preeminent specialty for the management of this disease. Because of the widespread prevalence of OSA, many patients undergoing upper airway surgery will have the disease and certain factors need to be considered in the perioperative setting to optimize patient outcomes.

With this session, we will utilize short lectures and a case-based panel discussion format to discuss the perioperative management of patients with OSA undergoing upper airway surgery. We will review airway management techniques and considerations of volatile gas versus total intravenous anesthesia. We will discuss the perioperative analgesia management and timing of reinstitution of positive airway pressure therapy. PAP management is of particular interest and concern in patients undergoing sinus or skull base surgery. Lastly, we will discuss the factors to consider when deciding to perform ambulatory surgery.

OUTCOME OBJECTIVE 1: Understand the Anesthetic considerations in patients with obstructive sleep apnea regarding their airway management and anesthetic choice.

OUTCOME OBJECTIVE 2: Discuss factors impacting the decision to perform ambulatory surgery as opposed to overnight admission.

OUTCOME OBJECTIVE 3: Discuss the postoperative management of patients undergoing Otolaryngologic surgery for OSA including the use of narcotic medications and the use of positive pressure therapy.

BACKGROUND STATEMENT: Obstructive sleep apnea (OSA) is a disease increasing in incidence. As it disease becomes more commonplace, physicians will need to become facile in the preoperative management of patients with the comorbidity. This includes knowledge of airway management, anesthetics, and pain control.