NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE IN THE PERIOPERATIVE MANAGEMENT OF PATIENTS WITH OBSTRUCTIVE SLEEP-APNEA SUBMITTED TO SURGERY

Anesthetic, sedative, and analgesic drugs have been shown in animals a nd humans to selectively impair upper airway muscle activity. In patie nts with an already compromised upper airway, these drugs may further jeopardize upper airway patency, especially during sleep. Thus, patien ts with obstructive sleep apnea syndrome (OSAS) are at high risk for s urgery because of the use of the aforementioned drugs in the periopera tive period. It has been recommended that such drugs should be avoided or used with extreme caution in patients with OSAS submitted to surge ry. We report herein on 16 adult patients with documented OSAS undergo ing various types of surgical procedures, including coronary artery by pass surgery. Anesthesia was carried on with the usual type of drugs f or each type of surgery. Postoperative opioid analgesia and sedation w ere not restricted. The first patient, whose OSAS was diagnosed but no t treated, died after various complications, including a respiratory a rrest in the ward. The second patient experienced serious postoperativ e complications until a treatment for OSAS with nasal continuous posit ive airway pressure (N-CPAP) was instituted, and thereafter he made an uneventful recovery. The 14 following patients were started on N-CPAP before surgery, were put on N-CPAP as soon as extubated, on a near-co ntinuous basis, for 24 to 48 h and thereafter for all sleep periods. N one of them had major complications. The intensive care unit and hospi tal stays were the normal ones for each type of surgery in our institu tion. We conclude that N-CPAP started before surgery and resumed immed iately after extubation allowed us to safely manage a variety of surgi cal procedures in patients with OSAS, and to freely use sedative, anal gesic, and anesthetic drugs without major complications. Every effort should be made to identify patients with OSAS and institute N-CPAP the rapy before surgery.