OBSTRUCTIVE SLEEP-APNEA SURGERY - RISK MANAGEMENT AND COMPLICATIONS

BACKGROUND: Hypoxemia, hypertension, airway obstruction, and death hav e been associated with surgery for obstructive sleep apnea syndrome (O SAS), Patient analysis was undertaken to identify potential factors th at could affect risk-management outcome, METHODS: One hundred eighty-t wo consecutively treated patients with OSAS undergoing 210 procedures were evaluated. Fifty-four factors were analyzed. RESULTS: Group chara cteristics included a mean age of 48.2 years, a mean respiratory distu rbance index of 42.3, and a mean low oxyhemoglobin desaturation (LSAT) of 77.5%. Surgery included a combination of uvulopalatopharyngoplasty (162 patients; 77%) and maxillofacial procedures (173 patients; 82%). Patients with a respiratory disturbance index greater than 40 and an LSAT less than 80% (117 patients; 64%) were maintained on nasal contin uous positive airway pressure, Thirty-nine patients (18.6% had difficu lt intubations. There was a positive correlation (p > 0.001) of diffic ult intubations, neck circumference (> 45.6 cm) and skeletal deficienc y (Sella-Nasion-Point V < 75 degrees). All tubes were removed with the patient awake in the operating room with two transient episodes of ai rway obstruction. One hundred forty-eight of the patients (70.5%) requ ired postoperative intravenous antihypertensive medications. Patients with a preoperative history of hypertension had a significantly increa sed risk (p > 0.01) of requiring intraoperative and postoperative intr avenous antihypertensive medications. The mean hospital stay was 2.2 d ays (SD +/- 0.9). Analgesia was achieved with intravenous morphine sul fate or meperidine HCl (intensive care unit) and oral oxycodone (non-i ntensive care unit). There were no significant oxyhemoglobin desaturat ions, irrespective of severity of OSAS or. obesity (mean LSAT day 1, 9 4.8% (SD +/- 2.4); mean LSAT day 2, 95.5% (SD +/- 1.6)). Complications included postoperative bleeding (n = 4), infection (n = 5), seroma (n = 3), arrhythmia (n = 4), angina (n = 1), and loss of skeletal fixati on (n = 1). CONCLUSION: Intraoperative airway risks can be reduced by use of fiberoptic intubation in patients with increased neck circumfer ence and skeletal deficiency, Patients with OSAS are at a significantl y increased risk for hypertension, Nasal continuous positive airway pr essure eliminated the postoperative risk of hypoxemia, which allowed t he use of adequate parenteral or oral analgesics.