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Hao Wu, Qianwen Lv, Huina Zhang, Yanwen Qin, Fang Fang, Haili Sun, Yongxiang Wei
PURPOSE: We aimed to investigate the effect of obstructive sleep apnea (OSA) and apnea-hypopnea duration on endothelial, ventricular function, blood pressure, and inflammation in a rat model. METHODS: We established a novel rat model of OSA. Wistar rats were randomized to six groups according to 4-week different treatments: (1) OSA (apnea for 60 s in a 90-s window of breathing [60 s/90 s] with anesthesia), (2) OSA 30 s/90 s with anesthesia, (3) partial recovery (60 s/90 s for 2 weeks, followed by 15 s/90 s for 2 weeks with anesthesia), (4) complete recovery (60 s/90 s for 2 weeks with anesthesia, and then normal breathing for 2 weeks), (5) sham (normal breathing in the device with anesthesia), and (6) control group (normal breathing, normal cage, no anesthesia)...
February 14, 2019: Sleep & Breathing, Schlaf & Atmung
Jason M Goldberg, Michael P Johnson, Michael J Safian
PURPOSE: Oral and maxillofacial surgeons often treat patients with both diagnosed and undiagnosed obstructive sleep apnea (OSA). Patients with OSA are at substantial risk of perioperative and postoperative complications after receiving intravenous sedation, general anesthesia, or postoperative opiate analgesia. The purpose of this study was to determine whether oral and maxillofacial surgery (OMS) providers are screening patients for perioperative and postoperative risks related to OSA before office-based ambulatory anesthesia...
January 15, 2019: Journal of Oral and Maxillofacial Surgery
X Zhang, Y H Liu, J Wu, C B Gao, Y Zhao, Y Wang, D Wang
Objective: To explore the clinical value of modified cricothyrotomy in the multiplane surgery under general anesthesia for patients with severe obstructive sleep apnea hypopnea syndrome(OSAHS). Method: A retrospective review was made among 20 cases with severe OSAHS treated a concurrent multiplane surgery under the condition of modified cricothyrotomy with general anesthesia, performed during recent 3 years, with their clinical data reviewed carefully. General anesthesia was carried out by inserting trachea cannula through mouth at first, and then, modified cricothyrotomy was performed via a transverse incision, followed by pulling out trachea cannula and inserting endotracheal tube through thyrocricoid incision...
November 2018: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Devika Bhatt, Ulpesh Shelke, Varsha Vyas, R P Gehdoo
Obstructive sleep apnea may be associated with numerous comorbidities and perioperative complications. Poor laryngeal anatomy visualization can be a cause of failed tracheal intubation after multiple attempts in patients with sleep-disordered breathing due to the underlying adenoid enlargement. We present a case of difficult endotracheal intubation in a 52-year-old menopausal female patient posted for tonsillectomy with adenoid resection with a history of snoring and difficulty in breathing while asleep. A thorough preoperative assessment focusing on history and investigating obstructive sleep apnea, and preparing and planning for difficult tracheal intubation in such patients can lead to successful endotracheal intubation inside the operation theater...
October 2018: Anesthesia, Essays and Researches
Lukas Pichler, Sarah M Weinstein, Crispiana Cozowicz, Jashvant Poeran, Jiabin Liu, Lazaros A Poultsides, Jawad N Saleh, Stavros G Memtsoudis
BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is a risk factor for adverse postoperative outcome and perioperative professional societies recommend the use of regional anesthesia to minimize perioperative detriment. We studied the impact of OSA on postoperative complications in a high-volume orthopedic surgery practice, with a strong focus on regional anesthesia. METHODS: After Institutional Review Board approval, 41 766 cases of primary total hip and knee arthroplasties (THAs/TKAs) from 2005 to 2014 were extracted from institutional data of the Hospital for Special Surgery (approximately 5000 THAs and 5000 TKAs annually, of which around 90% under neuraxial anesthesia)...
January 11, 2019: Regional Anesthesia and Pain Medicine
Patrick Henley, Jason R Foreman, Benzy J Padanilam, Girish V Nair, Jeff A Olson, Sandeep Joshi, Zaid Aziz, Todd Foster, Eric N Prystowsky
INTRODUCTION: Focal impulse and rotor modulation (FIRM)-guided ablation has had mixed results of published success, and most studies have had follow-up for a year or less. We aimed to study a consecutive group of patients followed for at least 1.5 years, subgrouped into those with an initial FIRM ablation and those with a previous failed ablation who now received a FIRM guided one, to evaluate for success in each group and factors that might affect success. METHODS: Of 181 patients, 167 were available for analysis...
December 22, 2018: Journal of Cardiovascular Electrophysiology
Sarah B Jacob, Guerin M Smith, Whitney N Rebholz, Elizabeth D Cash, Sasi R Kalathoor, Julie L Goldman, Swapna K Chandran
OBJECTIVE: To determine whether anesthesiologists need to rely on polysomnography (PSG) when predicting need for airway intervention during induction in patients with sleep-disordered breathing (SDB). METHODS: Prospective case-control observational study at a tertiary care pediatric hospital. Children between the ages of 2-17 undergoing tonsillectomy were divided into three groups: those presenting with OSA observed by history and/or physical examination alone (SDB; n = 33), those with OSA determined by preoperative PSG (OSA; n = 32), and a control group (n = 35) undergoing tonsillectomy for recurrent tonsillitis...
November 13, 2018: International Journal of Pediatric Otorhinolaryngology
Akane Kohno, Yuji Kitamura, Shinichiro Kato, Hirohisa Imai, Yoshitada Masuda, Yasunori Sato, Shiroh Isono
Study Objectives: Animal studies suggest a pivotal role of the hyoid bone in obstructive sleep apnea (OSA). We aimed to explore the role of the hyoid bone in humans by testing the hypotheses that muscle paralysis and lung volume (LV) changes displace the hyoid bone position particularly in patients with obesity and/or OSA. Methods: Fifty patients undergoing general anesthesia participated in this study (20 non-obese, non-OSA subjects; 8 non-obese patients with OSA; 22 obese OSA patients)...
October 29, 2018: Sleep
Soeren Wagner, Joerg Quente, Sven Staedtler, Katharina Koch, Tanja Richter-Schmidinger, Johannes Kornhuber, Harald Ihmsen, Juergen Schuettler
BACKGROUND: The obstructive sleep apnea syndrome (OSAS) is characterized by temporary cerebral hypoxia which can cause cognitive dysfunction. On the other hand, hypoxia induced neurocognitive deficits are detectable after general anesthesia. The objective of this study was to evaluate the impact of a high risk of OSAS on the postoperative cognitive dysfunction after intravenous anesthesia. METHODS: In this single center trial between June 2012 and June 2013 43 patients aged 55 to 80 years with an estimated hospital stay of at least 3 days undergoing surgery were enrolled...
October 2, 2018: BMC Anesthesiology
Zyad J Carr, Brian Vells, Brendan R Wood, Joshua D Lowery, Ann M Rogers, Allen A Kunselman, Kunal Karamchandani, Sonia J Vaida
BACKGROUND: We theorized that modafinil, an atypical psychomotor stimulant, utilized to improve daytime somnolence in patients with obstructive sleep apnea, would improve functional recovery after general anesthesia by improving time to extubation, post-anesthesia care unit (PACU) length of stay and subjective recovery after general anesthesia. METHODS: A double blind, randomized, placebo-controlled pilot study was performed. 102 patients with the diagnosis of obstructive sleep apnea (OSA) were randomized to receive either 200 mg of modafinil or placebo before general anesthesia...
September 2018: Medicine (Baltimore)
Mahesh Nagappa, Yamini Subramani, Frances Chung
PURPOSE OF REVIEW: The perioperative outcome in obstructive sleep apnea (OSA) patients undergoing ambulatory surgery can be potentially impacted by the type of anesthetic technique, fluid management and choice of anesthetic agents. This review highlights the best perioperative practices in the management of OSA patients undergoing ambulatory surgical procedures. RECENT FINDINGS: A recent meta-analysis found that STOP-Bang might be used as a perioperative risk stratification tool...
December 2018: Current Opinion in Anaesthesiology
Shiue-Chin Liou, Chen-Ming Hsu, Chit Chen, Ming-Yao Su, Cheng-Tang Chiu
Background: Subjects with obstructive sleep apnea (OSA) are vulnerable to sedation-related complications during endoscopic procedures. A significant portion of subjects undergoing routine endoscopy is at high risk of OSA, but most are undiagnosed. The purpose of this study was to estimate the prevalence of high risk for OSA among Chinese subjects undergoing deep sedation for screening gastrointestinal endoscopy and to evaluate the hypoxemia risk of these examinees stratified by Berlin Questionnaire (BQ)...
2018: Therapeutics and Clinical Risk Management
Patricia Strutz, William Tzeng, Brianna Arrington, Vanessa Kronzer, Sherry McKinnon, Arbi Ben Abdallah, Simon Haroutounian, Michael S Avidan
Introduction : Postoperative delirium and pain are common complications in adults, and are difficult both to prevent and treat. Obstructive sleep apnea (OSA) is prevalent in surgical patients, and has been suggested to be a risk factor for postoperative delirium and pain. OSA also might impact pain perception, and alter pain medication requirements. This protocol describes an observational study, with the primary aim of testing whether OSA is an independent predictor of postoperative complications, focusing on (i) postoperative incident delirium and (ii) acute postoperative pain severity...
2018: F1000Research
Evgeny Goloborodko, Ann Christina Foldenauer, Nassim Ayoub, Matthias Knobe, Stephan Christian Möhlhenrich, Kristian Kniha, Frank Hölzle, Ali Modabber
Patients with sleeping disorders, such as obstructive sleep apnea, (OSA) have a higher risk for postoperative complications after maxillofacial surgery under general anesthesia. The aim of this study was to detect specific complications after oral and maxillofacial surgery. Sixty-nine cases of patients with middle or severe sleep apnea who underwent an operation under general anesthesia in the oral and maxillofacial region were retrospectively analyzed. This group was compared with an age and diagnosis matched group without sleep apnea receiving the same operative treatment...
September 2018: Journal of Cranio-maxillo-facial Surgery
Stavros G Memtsoudis, Crispiana Cozowicz, Mahesh Nagappa, Jean Wong, Girish P Joshi, David T Wong, Anthony G Doufas, Meltem Yilmaz, Mark H Stein, Megan L Krajewski, Mandeep Singh, Lukas Pichler, Satya Krishna Ramachandran, Frances Chung
The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence...
October 2018: Anesthesia and Analgesia
Sandeep Jain, Peter J Kallio, Kenneth Less, Jutta Novalija, Paul S Pagel, Thomas J Ebert
Background: Nasal fiberoptic videoendoscopy is an established technique to assess upper airway pathology in conscious and sedated patients. Objectives: The authors conducted a prospective proof-of-concept pilot study to evaluate whether airway narrowing detected using nasal fiberoptic videoendoscopy in the anesthesia preoperative clinic was capable of defining the severity of obstructive sleep apnea (OSA) in patients scheduled for elective surgery. Methods: After application of topical local anesthesia (4% lidocaine with phenylephrine), sixteen patients (ASA physical status 2 or 3) underwent nasal fiberoptic videoendoscopy in sitting position...
February 2018: Anesthesiology and Pain Medicine
Nana Li, Linjia Zhu, Jie Sun, Yinbing Pan, Mei Gao
RATIONALE: Tracheobronchomalacia (TBM) refers to the weakening trachea or the trachea loss of structural integrity of airway cartilaginous structures. It causes tracheal stenosis, resulting in significantly high rates of mortality. Bronchoplasty by high-pressure balloon dilation under general anesthesia is a simple but effective and safe method to treat tracheobronchial stenosis. However, recurrent postoperative dyspnea after extubation due to tracheal collapse is still a challenge for anesthetists...
June 2018: Medicine (Baltimore)
Ruchir Gupta, Srinivas Pyati
As the number of procedures being performed in the office-based anesthesia (OBA) setting are increasing, so are the number of patients presenting for surgery with obstructive sleep apnea (OSA). There continues to be controversy regarding whether these patients can be safely cared for in the OBA setting. To date, no national guideline has clearly addressed this issue and while some have extrapolated lessons from what has been published for OSA in the ambulatory surgery center (ASC) setting, some argue that there is a significant difference in the availability of resources in the ASC versus the OBA setting...
September 2018: Minerva Anestesiologica
Macario Camacho, Justin M Wei, Lauren K Reckley, Sungjin A Song
Objectives: During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place...
2018: Anesthesiology Research and Practice
Jill Setaro, Ruth Reinsel, Dana Brun
PURPOSE: Practice guidelines from the perianesthesia community suggest that preoperative identification of patients with obstructive sleep apnea (OSA) and standardized longer observation in postanesthesia care unit (PACU) promotes safety after general anesthesia. The purpose of this study was to determine if longer monitoring of patients with OSA in the PACU improves patient outcomes after general anesthesia. DESIGN: Evidence-based best practices literature review...
May 10, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
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