OSA

Question 1

STOP BANG

Answer 1

S-Snoring
T-Tired during Day
O-observed snoring
P-Pressure (HTN)

B-BMI >35
A-Age >50
N-Neck circumference >40 cm
G-Gender (male)

0-2 low risk
3-4 intermediate
5-8 high risk

Question 2

Apnea/hypopnea index-average number of apneas (full airway obstruction) and hypopnea (partial airway obstruction)

Answer 2

Mild 5-15
Moderate: 16-30
Severe: >30

Question 3

Can patient have successful UP3 procedure and still have severe sleep apnea?

Answer 3

Yes-success is only a 50% improvement

Question 4

Preoperative concerns for patients with OSA:

Answer 4

Increased risk for difficult intubation
Post operative hypoxemia
Post operative airway obstruction requiring need for re-intubation

Question 5

KIM that all CNS depressant drugs (inhaled agents, hypnotic, narcotics) as well as muscular relaxants do what to pharyngeal muscles? What can CNS relaxants impair?

Answer 5

cause relaxation of pharyngeal muscles
It will impair the arousal state which terminates apneic episodes, which predisposes the patient to hypoxemia and hypercarbia

Question 6

KIM that you ALWAYS have to have a back up plan for regional, so if regional is your main plan but you knooowwww you wouldn’t do GA in a patient (say at an outpatient surgery center-cancel it!)

Answer 6

Otay

Question 7

Every OSA patient needs a thorough ___ and __ exam. Have patients bring what?

Answer 7

cardiac and pulmonary. Have patients bring machine even if they’re not using it.

Question 8

PACU and OSA-what determines which floor they will go to? OSA is not a reason to not give pain meds (T/F)

Answer 8

If pt doing well in PACU without evidence of apneas/hypoxemia, they can go to monitored bed with continuous pulse ox following procedure. If they had issues of apnea and defat-they will need to go to ICU> True-they still need pain meds, they just have to have increased monitoring when receiving them

Question 9

Effects of beach chair positioning

Answer 9

In the awake patient, the beach chair position results in decreased
cerebral perfusion pressure (approximately 15% decrease in the nonanesthetized
patient), stroke volume, and cardiac output. These effects are at least partially
compensated for by an increase in systemic vascular resistance (up to 50-80%).

However, under general anesthesia, this compensatory increase in systemic vascular
resistance is inhibited, further compromising cardiac output and cerebral perfusion
pressure and, therefore, placing the patient at increased risk of cerebral ischemia.

Moreover, this patient exhibits signs of diabetic autonomic neuropathy which could
further impair her ability to compensate for the reduction in cerebral perfusion that is
likely to occur when she is placed in the beach chair position (secondary to impaired
peripheral vasoconstriction and baroreceptor function).