Last week we discussed how to screen patients for undiagnosed sleep apnea. This week, let's continue the discussion by delving into practical considerations for sleep apnea management. There are many factors to consider, but we want to focus on what’s practical and within the surgery center’s scope. We want to focus on easy-to-implement, cost-effective, efficient ways to best help these patients.
First things first
First of all, if a patient who has been diagnosed with sleep apnea is having surgery, make sure they bring their apnea mask to their appointment. Second, because these patients are at high risk of desaturating, aim to minimize using sedatives or narcotics as much as you can. One of the ways you can do this is by utilizing multimodal anesthesia, over-the-counter pain relievers, and, whenever possible, opt for regional anesthesia.
What if a patient desaturates?
If we don’t take these precautions, these patients are at risk of desaturating while in surgery. And in fact, despite taking all these extra measures, if you treat enough patients with a high BMI, some of them will desaturate. In these cases, there are some maneuvers you should be prepared to implement:
- Jaw lift: Many of these patients have obstructed airways because of the extra soft tissue and folds above the vocal cords. Doing a jaw lift will help lift those soft tissues off of the airway.
- Appropriately-sized oral airways: One of the common mistakes in airway management is using too small or short of an oral airway. When you use these, you run the risk that the oral airway doesn’t go all the way to the larynx and is still obstructed by soft tissue. You must make sure that you have appropriately-sized oral airways that are large enough to go from the patient’s teeth and lips all the way down to the larynx.
- Ambu bag: Ambu bags, or “artificial manual breathing units” can help to manually resuscitate a patient who is not breathing or is not breathing adequately on their own. Use the positive pressure ventilation with a bag standing-by and readily available that has a source of oxygen.
- If these measures fail to help the patient breathe adequately, then you should intubate the patient or use a laryngeal mask airway (LMA).
Risks of sleep apnea
Patients who have untreated sleep apnea are more likely to have right heart failure, and are highly likely to have an arrhythmia such as atrial fibrillation (AFib). These patients are 3 times more likely to suffer a stroke and more likely to have driving-related accidents. Screening for, diagnosing, and managing sleep apnea are vital to helping your patients live a healthier, higher quality of life.
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