CONSERVATION OF RESOURCES - INDICATIONS FOR INTENSIVE-CARE MONITORINGAFTER UPPER AIRWAY SURGERY ON PATIENTS WITH OBSTRUCTIVE SLEEP-APNEA

Although significant complications cars result after upper airway surg ery for obstructive sleep apnea (OSA), there is a lack of consensus re garding the most appropriate level of monitoring in the perioperative period. A retrospective analysis was performed on the operative record s of 109 adult patients who underwent 125 surgical procedures from Jan uary 1, 1991, to May 31, 1996, with particular emphasis ore complicati ons that would have mandated intensive care monitoring and management. Airway complications occurred in one patient (0.8%), who became obstr ucted immediately after surgery; he responded to naloxone and suctioni ng. Five other patients (4%) suffered oxygen desaturation to levels be low 90% (none fell below 80%, and in only one case was it below the lo west preoperative oxygen saturation level). Cardiac complications, pri marily significant hypertension, were the most common adverse events. Four (3.2%) bleeding complications were encountered: all occurred afte r discharge from the hospital, Routine postoperative intensive care mo nitoring for all adult patients undergoing upper airway surgery for OS A is unnecessary Although high-risk patients cannot always be identifi ed preoperatively, significant complications generally emerge within 2 hours after surgery. Therefore a decision regarding the level of post operative monitoring needed may be made with confidence during the per iod of time that the patient is in the recovery room.