Term
| How does general anesthesia affect the number of sleep apneas? |
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Definition
| Increases the number and duration as well as inhibits arousals that would occur during sleep |
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Term
| What are considerations for the OSA patient in the pre and post op period? |
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Definition
Pre: ask screening questions
Post: consider monitoring for several hours following GA through at least one full natural sleep period; ascertain that breathing will not be obstructed; anticipate that patients with OSA may require longer periods of care than patients without OSA |
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Term
| What are airway considerations for the patient with OSA? |
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Definition
- Consider potential for postop resp. depression with meds
- CPAP during sedation if use CPAP at home
- Difficult airway precautions, equipment
- Neuraxial anesthesia?
- Extubate fully awake
- Completely antagonize NDMR
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Term
| What are postop implications for patients with OSA? |
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Definition
- residual anesthetics worsen OSA due to decreased pharyngeal tone and blunted responses to hypoxia/obstruction
- supine position aggrevates OSA
- NG tubes decrease airway caliber requiring increased inspiratory effort = (-) pharyngeal pressures and increased likelihood of airway collapse
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Term
| What are some ASA guidelines for postop management of OSA patients? |
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Definition
- Decrease opiod requirements through use of regional techniques, NSAIDS, caution with (or avoid) continuous PCA modes
- Caution with versed as it increases risk of airway obstruction and respiratory depression
- Adminster 100% FIO2 with PPV and place in nonsupine position to overcome loss of FRC
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Term
| Define obesity hypoventilation syndrome and what are symptoms upon which diagnosis is made? |
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Definition
DEF: extreme obesity with alveolar hypoventilation that occurs during wakefulness not just during sleep
Diagnostic symptoms: sudden somnolence, sleep apnea, hypoxia, hypercapnia |
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Term
| What is obesity hypoventilation syndrome characterized by? |
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Definition
- hypercapnia
- polycythemia
- RVH and RVF
- somnolence
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Term
| Why does a patient with obesity hypoventilation syndrome have polycythemia? |
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Definition
Polycythemia is related to chronic hypoxic compensation |
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Term
| Describe the pathophysiology of obesity hypoventilation syndrome. |
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Definition
- increased WOB that cannot be sustained
- decrease in drive to breath
- During sleep, hypoventilation leads to hypercapnea.
- Hypercapnea can reset chemoreceptors to tolerate elevated CO2 levels which can lead to sustained elevated CO2 levels during the day
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Term
| Describe pulmonary factors related to obesity hypoventilation syndrome. |
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Definition
- 90% also have OSA
- narrow airway, COPD
- alterations in lung compliance, chest wall motion, V/Q abnormalities, decreased respiratory muscle strength/endurance
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Term
| What are some signs and symptoms of obesity hypoventilation syndrome? |
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Definition
- In BMI>35, 48% have OHS
- In BMI>50, all have OHS
- loud snorers
- fatigue
- hypersomnelence
- inattention
- impaired memory
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Term
| What are treatment options for obesity hypoventilation syndrome? |
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Definition
Weight loss
ventilation support (CPAP)
possible TRACH |
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Term
| What are GI factors to consider in a patient with obesity hypoventilation syndrome undergoing anesthesia? |
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Definition
poor gastric emptying
hyperacidic gastric fluid (Mendelsen's)
increased pressure on stomach
GERD |
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Term
| What percent of non-insulin dependent diabetics are obese? |
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Definition
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