Hospital and Sleep Apnoea

Replies to This Discussion

Permalink Reply by Kath Hope on March 12, 2012 at 12:00

I've had 2 lots of surgery since being diagnosed with OSA, and the procedure that should be followed, which happened with me, is that you should be put onto the High Observation Unit of the hospital for close monitoring after the surgery.  It's also imperative that you use your CPAP immediately after the surgery in case you doze off.  If you need oxygen after the surgery, most masks have an oxygen port for them to insert the tube.  With the correct procedures in place, you should be in safe hands - it's the people with undiagnosed sleep apnoea that are more at risk!

If I were you I would try to avoid an anaesthetic, but I do understand because I'm due a biopsy on my tongue next month and dreading it :(

• ▶ Reply

Permalink Reply by Kath Hope on March 12, 2012 at 12:15

Have just remembered, Edward Grandi the Executive Director of the American Sleep Apnea Association (and a member on our forum) wrote a good article all about this:-

SLEEP APNOEA + SURGERY

"It is well known that sleep apnea can be a complicating factor in the administration of general anesthesia. It is also known that when the anesthesiologist is aware of the sleep apnea in the patient undergoing surgery and takes appropriate measures to maintain the airway, the risks of administering anesthesia to people with sleep apnea can be minimized.

Although there have been no clinical trials on anesthesia in sleep apnea patients, clinical experience confirms that anesthesia can be problematic in these patients. The cause of potential problems is seen in an anatomic and
physiologic understanding of sleep apnea: the syndrome of obstructive sleep apnea is characterized by repetitive episodes of upper airway obstruction during sleep. ("Apnea" literally means "without breath" and is clinically defined as a cessation of breath that lasts at least ten seconds.) Sleep apnea may be accompanied by sleep disruption and arterial oxygen desaturation.

General anesthesia suppresses upper airway muscle activity, and it may impair breathing by allowing the airway to close. Anesthesia thus may increase the number of and duration of sleep apnea episodes and may decrease arterial oxygen
saturation. Further, anesthesia inhibits arousals which would occur during sleep. Attention to sleep apnea should continue into the post-operative period because the lingering sedative and respiratory depressant effects of the anesthetic can pose difficulty, as can some analgesics.

Given the nature of the disorder, it may be fitting to monitor sleep apnea patients for several hours after the last dose of anesthesia and opioids or other sedatives, longer than non-sleep apnea patients require and possibly
through one full natural sleep period. Hence there is concern that same-day surgery (also known as out-patient or ambulatory surgery) may not be appropriate for some sleep apnea surgery patients.

Before surgery, the anesthesiologist should first conduct a thorough preoperative assessment (including history of anesthesia) and physical examination. The use of preoperative sedatives must be considered carefully as sedative medication, like anesthesia, suppresses upper airway muscle activity. During surgery, maintaining the patency of the airway is the anesthesiologist's primary concern. The period of awakening from anesthesia after surgery can also be problematic for sleep apnea patients. In patients who have undergone surgery to treat sleep apnea, the airway can be narrowed from swelling and inflammation. There may also be some upper airway swelling secondary to intubation and extubation. As mentioned, the lingering sedative and respiratory depressant effects of the anesthetic can pose difficulty. If narcotics are found to be necessary in the post-operative period, appropriate monitoring of oxygenation, ventilation, and
cardiac rhythm should be provided as narcotic analgesics can precipitate or potentiate apnea that may result in a respiratory arrest. Perioperative vigilance must continue into the postoperative period.

Many patients require postoperative intubation and mechanical ventilation until fully awake. Patients who already use a prescribed CPAP (Continuous Positive Airway Pressure) machine should utilize it, but the pressure should be
monitored to ascertain that it is adequate. CPAP can also be employed postoperatively in other patients without their own machine to support breathing. For certain patients, it may be judicious to admit them to an intermediate care or intensive care area postoperatively to facilitate close monitoring and airway support measures.

Therefore it is deemed wise to let sleep apnea patients remain in the care of medical personnel until it can be ascertained that their breathing will not be obstructed. While sleep apnea patients may require a longer period of time in
the care of medical personnel than would otherwise be required of the surgical procedure, this precaution is prudent and enables anesthesiologists to provide safe anesthetic care for sleep apnea patients.

Approved by the ASAA Board of Directors June, 1999.

It should be remembered that the overwhelming majority of sleep apnea cases have not been identified. Thus it is not sufficient simply to ask if a patient has sleep apnea. Instead, health care professionals must ask proper screening questions of their patients, especially those individuals at risk for sleep apnea and those children undergoing a tonsillectomy and adenoidectomy, before making decisions on patient care."

http://www.sleepapnea.org/about-asaa/position-statements/sleep-apne...

As is pointed out, people should ideally be screened for sleep apnoea before any surgery, but we don't live in an 'ideal world' but one day this might well be the case as people get to realize just how common sleep apnoea is.

• ▶ Reply

Permalink Reply by gina on March 12, 2012 at 15:46

The anaesthetist has to look at all risks and advise what is best.  With having sleep apnoea you will be classed as higher risk than normal  but all  anaesthetics  have a risk, and if possible at all times it is best to have an alternative if at all possible and listen to what the specialist says.  Having a spinal does not mean you will be in any more pain - in fact with what you are having done prob would be better.  Hope this helpsx

• ▶ Reply

Permalink Reply by Marion@As I Live and Breathe on March 12, 2012 at 17:21

A friend with Sleep Apnoea had a hysterectomy without general anaesthetic.
She was fine.

• ▶ Reply

Permalink Reply by Philip Dallinger on March 12, 2012 at 18:36

I have just spoken to the consultant it would appear we have come to an agreement with the anaesthetist to sedate me and then go for the spinal injection so I wont be aware whats going on anyway!!!

Its a man thing DOH!!

• ▶ Reply

Permalink Reply by Kath Hope on March 12, 2012 at 20:51

Good news Philip, but don't be falling asleep after sedation without the CPAP on.  As for the 'man thing' my husband's actually braver than me LOL.

Philip Dallinger said:

I have just spoken to the consultant it would appear we have come to an agreement with the anaesthetist to sedate me and then go for the spinal injection so I wont be aware whats going on anyway!!!

Its a man thing DOH!!

• ▶ Reply

Permalink Reply by David on March 13, 2012 at 9:22

I would have thought that when you have a general anaesthetic then your airway will be OK because you are intubated (tube down your throat) . It when you  recovering post op that you should use the machine or the Oxygen supply is delivered at a suitable pressure to maintain your airway.

• ▶ Reply

Permalink Reply by Philip Dallinger on March 13, 2012 at 14:57

That is true David it is the after care they are concerned about in fact the hospital I will be using as no High Dependency unit to look after you 1 to 1 that is why they were concerned>

Cheers Phil

• ▶ Reply

▶ Reply to Discussion