A patient with obstructive sleep apnea (OSA) requires careful perioperative management in order to avoid complications. Patients with OSA have died because precautions were not taken.


General management:

(1) A patient with OSA requires closer monitoring during and following surgery, especially if sedatives, opiates or supplemental oxygen are used.

(2) Regional anesthesia is safer than general anesthesia.

(3) Use sedatives as little as possible.

(4) Use of CPAP machine before and after surgery to maintain the airway. Often the patient's own CPAP machine is suitable, but it must be checked by biomedical services before it can be used in a hospital.

(5) If possible the patient should be placed in the lateral decubitus position during recovery.

(6) Use supplemental oxygen carefully.


Pain control:

(1) Avoid opiates as much as possible due to possible worsening of apnea.

(2) Use NSAIDs and local nerve blocks as much as possible.


The patient should not be extubated unless s/he are:

(1) conscious and alert

(2) communicative

(3) breathing spontaneously


Reasons to delay extubation include:

(1) severe OSA

(2) difficult intubation

(3) marked swelling in the mouth, oropharynx or airway

CPAP may be insufficient in these patients. Some patients may require prolonged intubation or event tracheostomy following surgery.


Additional issues after ENT surgery:

(1) If the patient has had nasal surgery, then a nasopharyngeal airway can be placed and any nasal packing can be placed around it.

(2) The presence of nasogastric or oral tubing may require the need for a facial mask for CPAP.


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