lunes, 1 de junio de 2015

Apnea obstructiva del sueño/Obstructive sleep apnea

Manejo perioperatorio y complicaciones en pacientes con apnea obstructiva del sueño sometidos a cirugía trans espenoidal
Perioperative management and complications in patients with obstructive sleep apnea undergoing transsphenoidal surgery: Our institutional experience.
Rahimi E, Mariappan R, Tharmaradinam S, Manninen P, Venkatraghavan L.
J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):351-4. doi: 10.4103/0970-9185.137266.
BACKGROUND AND AIMS: Patients with endocrine diseases such as acromegaly and Cushing's disease have a high prevalence of obstructivesleep apnea (OSA). There is controversy regarding the use of continuous positive airway pressure (CPAP) following transsphenoidal surgery. The aim of this study was to compare the perioperative management and complications, in patients with or without OSA undergoing transsphenoidal surgery. MATERIALS AND METHODS: After Research Ethics Board approval, we retrospectively reviewed the charts of all patients who underwent transsphenoidal surgery in our institution from 2006 to 2011. Information collected included patients' demographics, pathology of lesion, history of OSA, anesthetic and perioperative management and incidence of perioperative complications. Patients with sleep study proven OSA were compared with a control group, matched for age, sex and pathology of patients without OSA. Statistical analysis was performed using t-test and Chi-square test and the P < 0.05 was considered to be significant. RESULTS: Out of a total 469 patients undergoing transsphenoidal surgery, 105 patients were found to be at risk for OSA by a positive STOP-BANG scoring assessment. Preoperative sleep study testing was positive for OSA in 38 patients. Post-operative hypoxemia (SpO2 < 90) occurred in 10 (26%) patients with OSA and was treated with high-flow oxygen through face mask (n = 7) and by CPAP mask (n = 3). In the OSA-negative group, 2 patients had hypoxemia and were treated with low-flow oxygen using face mask. There were no differences between the groups with respect to post-operative opioid use, destination, hospital stay or other complications. CONCLUSIONS: Post-operative hypoxemia in patients with OSA following transsphenoidal surgery can be treated in most but not all patients with high flow oxygen using the face mask. We were able to safely use CPAP in a very small number of patients but caution is needed to prevent complications. Further prospective studies are needed to determine the safe use of CPAP in patients after transsphenoidal surgery.
KEYWORDS: Continuous positive airway pressure; obstructive sleep apnea; transsphenoidal surgery
Actualización en la definición, consecuencias y manejo de la apnea obstructiva del sueño
Updates on definition, consequences, and management of obstructive sleep apnea.
Park JG1, Ramar K, Olson EJ.
Mayo Clin Proc. 2011 Jun;86(6):549-54; quiz 554-5. doi: 10.4065/mcp.2010.0810.
Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and testing, complications of untreated OSA, perioperative considerations, treatment options, and new developments in this field.
Anestesia y Medicina del Dolor
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