deck_1527902 Flashcards
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 ___%
10 sec 5 or more per hour 4%
OSA: what % of general sx pts have OSA:
25% (just thought that is alot)
OSA: what are conditions that cause OSA
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
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)
from top to bottom airway tensor palatine Genio glossus Hyoid Muscles
OSA: what is the circular cycle of OSA 10 steps
Sleep decreased airway tone Obstruction Apnea decreased PO2 increased PCO2 Sympathetic Surge Arousal Increased airway tone Breathing resumes back to sleep and cycle restarts
OSA: Patho with OSA the obstructed breathing can cause decreased O2 and Increased CO2 wchich can leax to what complications
Arrhythmias- MI Pulmonary HTN- RVH Systemic HTN- LVH Daytime sleepiness-personality/behavior changes- accident prone
OSA: classification what are the 3 classifications?
Mild moderate Severe
OSA: classification what is the AHI (apnea/hypopnea index) for mild OSA
5-15 episodes/ hr
OSA: classification what are clinical findings with mild OSA
Mild sleepiness/insomnia Mild O2 desat Benign cadiac arrhythmia
*
OSA: classification what is the AHI for moderate OSA
15-30 episodes/hr
OSA: classification S/S of moderate OSA
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
OSA: classification what is severe OSA AHI
> 30 episodes/hr and/or Hypoxia < 90% for >20% of total sleep time
OSA: classification S/S of severe OSA
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
Screening for OSA: what is the gold standard for screening?
Polysomnography
Screening for OSA: what is the con of the polysomnography
Not practical for each surgical pt
Screening for OSA: what screening tool is good for primary care?
Berlin Questionnaire (usefullness w/ surgical pt’s has not been established)
Screening for OSA: what is overall the most practical screening tool?
STOP-BANG questionaire
Screening for OSA: what all does the Polysomnography test, test for?
Brain activity for sleep eye movement Air movement Muscle tone (pharynx neck) heart action Chest movement Abd movement O2 saturation Leg movement
Screening for OSA: the berlin questionaire is 3 categories and 10 questions, 1 positive score for OSA is what?
2 points or more in cat 1 2 or > points in cat 2 if #10 is yes and BMI > 30 in cat 3
Screening for OSA: w/ the berlin you have a high risk for OSA if what? And a low risk for OSA if what?
2 or more cat pos (high risk) only 1 cat or no cat pos
Screening for OSA: STOP-BANG tell me all the questions
- 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!
Screening for OSA: w/ STOP-BANG what scores show a high risk? what scores show a low risk?
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)
OSA: treatment what is teh treatment?
CPAP Oral appliances Behavioral modification Surgical intervention
OSA: what is central Sleep Apnea (CSA)
cessation of airflow w/o respiratory effort
OSA: CSA when does CSA occur?
when PCO2 falls below apneic threshold
OSA: CSA makes up what % of all sleep anpea cases
20%
CSA: what are the 3 types
Cheyne-stokes breathing Idiopathic central apnea Narcotic induced central apnea
CSA: what is the etiology of CSA?
NM d/o Excessive resp load (obesity) D/O of central ventilatory control (CVA) Endocrine/metabolic
CSA: treatment
Optimize medical therapy CPAP Oxygen Inhaled Co2 Acetazolamide Theophylline
OSA: Anesthestic implications: pwhat should you do preop?
STOP-BANG talk to family members If they use CPAP bring machine for post-op Regional vs GETA Airway assessment
OSA: Anesthestic implications: intraop
Anticipate difficult airway GETA vs deep sedation Spinal or Epidural for LE procedures Concientious Anesthestic choices Adjuncts for pain control NMBD fully reversed
OSA: Anesthestic implications: Extubation
Fully awake Semi-upright position Airway exchanger catheter
OSA: Anesthestic implications: Postop what to consider
Consider status of OSA (treated vs Untreated) Anotommical abnormalities Levels of co-morbidities type of sx Anesthesia modality Postop opioid use
Thats it
Thanks RTFF
