deck_1527902

Question 1

OSA: definition OSA is the cessation of airflow for more than ____ seconds dispite continuing ventilation effort, ____ or more times per ____ of sleep, and is usually associated w/ a decrease in arterial O2 saturation SAO2 or more than ___%

Answer 1

10 sec 5 or more per hour 4%

Question 2

	OSA:	what % of general sx pts have OSA:

Answer 2

25% (just thought that is alot)

Question 3

OSA: what are conditions that cause OSA

Answer 3

Obesity Race/genetics Age Male Alcohol/sedatives/analgesics/anesthestics Smoking Nasal/pharyngeal/laryngeal obstruction Cranio-facial abnormality endocrine/metabolic d/o Connective tissue d/o Storage diseases Chronic renal failure

Question 4

OSA: what are the 3 main muscles of the upper airway that are considered dilator muscles? (they are the ones that keep the airway open)

Answer 4

from top to bottom airway tensor palatine Genio glossus Hyoid Muscles

Question 5

OSA: what is the circular cycle of OSA 10 steps

Answer 5

Sleep decreased airway tone Obstruction Apnea decreased PO2 increased PCO2 Sympathetic Surge Arousal Increased airway tone Breathing resumes back to sleep and cycle restarts

Question 6

OSA: Patho with OSA the obstructed breathing can cause decreased O2 and Increased CO2 wchich can leax to what complications

Answer 6

Arrhythmias- MI Pulmonary HTN- RVH Systemic HTN- LVH Daytime sleepiness-personality/behavior changes- accident prone

Question 7

OSA: classification what are the 3 classifications?

Answer 7

Mild moderate Severe

Question 8

OSA: classification what is the AHI (apnea/hypopnea index) for mild OSA

Answer 8

5-15 episodes/ hr

Question 9

OSA: classification what are clinical findings with mild OSA

Answer 9

Mild sleepiness/insomnia Mild O2 desat Benign cadiac arrhythmia
*

Question 10

OSA: classification what is the AHI for moderate OSA

Answer 10

15-30 episodes/hr

Question 11

OSA: classification S/S of moderate OSA

Answer 11

Moderate daytime sleepiness, fatigue that interferes w/ ADLs Moderte O2 desat Mild arrhythmias At risk for injuries/accidents At risk for HTN/MI/Stroke/Cor pulmonale

Question 12

OSA: classification what is severe OSA AHI

Answer 12

> 30 episodes/hr and/or Hypoxia < 90% for >20% of total sleep time

Question 13

OSA: classification S/S of severe OSA

Answer 13

daytime sleepiness interferes w/ normal activities Severe O2 desat Moderate to severe cardiac arrhythmia At increased risk for injuries/accidents At risk for HTN, MI, Stroke, and cor pulmonale

Question 14

Screening for OSA: what is the gold standard for screening?

Answer 14

Polysomnography

Question 15

Screening for OSA: what is the con of the polysomnography

Answer 15

Not practical for each surgical pt

Question 16

Screening for OSA: what screening tool is good for primary care?

Answer 16

Berlin Questionnaire (usefullness w/ surgical pt’s has not been established)

Question 17

Screening for OSA: what is overall the most practical screening tool?

Answer 17

STOP-BANG questionaire

Question 18

Screening for OSA: what all does the Polysomnography test, test for?

Answer 18

Brain activity for sleep eye movement Air movement Muscle tone (pharynx neck) heart action Chest movement Abd movement O2 saturation Leg movement

Question 19

Screening for OSA: the berlin questionaire is 3 categories and 10 questions, 1 positive score for OSA is what?

Answer 19

2 points or more in cat 1 2 or > points in cat 2 if #10 is yes and BMI > 30 in cat 3

Question 20

Screening for OSA: w/ the berlin you have a high risk for OSA if what? And a low risk for OSA if what?

Answer 20

2 or more cat pos (high risk) only 1 cat or no cat pos

Question 21

Screening for OSA: STOP-BANG tell me all the questions

Answer 21

• S- Do you SNORE loudly (louder than talking or can be heard through a closed dorr)
• T- do you often feel TIRED, fatigued, or sleepy during the daytime?
• O- has anyone OBSERVED you stop breathing during your sleep?
• P- do you have or are you being treated for high blood PRESSURE? B- BMI > 35kg/m2
• A- AGE > 50
• N- NECK circumference > 40 cm?
• G- GENDER male stop is subjective-do you/ have you/ has anyone? Bang- is objective- things we see!

Question 22

Screening for OSA: w/ STOP-BANG what scores show a high risk? what scores show a low risk?

Answer 22

high risk- yes to > 3 items Low risk- yes to < 3 items like rudy said tough b/cas men we are starting w/ 2 points we are always tired and male, and DWAYNE is over 50 so he basically has OSA automatically (sorry to bare the bad news)

Question 23

OSA: treatment what is teh treatment?

Answer 23

CPAP Oral appliances Behavioral modification Surgical intervention

Question 24

OSA: what is central Sleep Apnea (CSA)

Answer 24

cessation of airflow w/o respiratory effort

Question 25

OSA: CSA when does CSA occur?

Answer 25

when PCO2 falls below apneic threshold

Question 26

OSA: CSA makes up what % of all sleep anpea cases

Answer 26

20%

Question 27

CSA: what are the 3 types

Answer 27

Cheyne-stokes breathing Idiopathic central apnea Narcotic induced central apnea

Question 28

CSA: what is the etiology of CSA?

Answer 28

NM d/o Excessive resp load (obesity) D/O of central ventilatory control (CVA) Endocrine/metabolic

Question 29

CSA: treatment

Answer 29

Optimize medical therapy CPAP Oxygen Inhaled Co2 Acetazolamide Theophylline

Question 30

OSA: Anesthestic implications: pwhat should you do preop?

Answer 30

STOP-BANG talk to family members If they use CPAP bring machine for post-op Regional vs GETA Airway assessment

Question 31

OSA: Anesthestic implications: intraop

Answer 31

Anticipate difficult airway GETA vs deep sedation Spinal or Epidural for LE procedures Concientious Anesthestic choices Adjuncts for pain control NMBD fully reversed

Question 32

OSA: Anesthestic implications: Extubation

Answer 32

Fully awake Semi-upright position Airway exchanger catheter

Question 33

OSA: Anesthestic implications: Postop what to consider

Answer 33

Consider status of OSA (treated vs Untreated) Anotommical abnormalities Levels of co-morbidities type of sx Anesthesia modality Postop opioid use

Question 34

	Thats it

Answer 34

Thanks RTFF