To determine whether high risk scores on preoperative STOP-BANG (Snoring, Tiredness during daytime, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, Gender) questionnaires during preoperative evaluation correlated with a higher rate of complications of obstructive sleep apnea syndrome (OSAS).
Historical cohort study.
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Adult patients undergoing elective surgery at a tertiary care center who were administered the STOP-BANG questionnaire for 3 consecutive days in May 2008.
Number and types of complications.
A total of 135 patients were included in the study, of whom 56 (41.5%) had high risk scores for OSAS. The mean (SD) age of patients was 57.9 (14.4) years; 60 (44.4%) were men. Patients at high risk of OSAS had a higher rate of postoperative complications compared with patients at low risk (19.6% vs 1.3%; P < .001). Age, American Society of Anesthesiologists class of 3 or higher, and obesity were associated with an increased risk of postoperative complications. On multivariate analysis, high risk of OSAS and American Society of Anesthesiologists class 3 or higher were associated with higher odds of complications.
The STOP-BANG questionnaire is useful for preoperative identification of patients at higher than normal risk for surgical complications, probably because it identifies patients with occult OSAS.
"An additional point is added for each of the following conditions: a BMI of more than 35 kg/m 2 , an age of 50 years or greater, a neck circumference of greater than 40 cm, and male gender. A total score of three or more places the individual at a high risk for OSA . PSG: This procedure was performed at either the patient's home using type 2 devices (Somnotouch; Somnomedics and Embletta X100; Natus) or the sleep laboratory using type I devices (Somnoscreen EEG32; Somnomedics and Z4 Sleep System; Somnostar). "
[Show abstract][Hide abstract] ABSTRACT: Command Surgeon, HQ AFSOC As you know, this is my last article as president of the society. It has been a great pleasure serving as the presi-dent for the past year. It was wonderful seeing everyone in Atlanta during AsMA. We had an outstanding turnout for both the social and luncheon. Col (ret) Tom McNish presented an amazing luncheon speech on his career and time as a POW. Lt Gen Ogata (previously, the Japanese Self-Defense Force Surgeon General and currently the Vice President of the National Defense Medical University – Japan's USUHS) thanked the society for our support to Operation Tomadachi in Japan last year. Finally, congrats to those awarded our society awards. This year the society became the official sponsor of the Team Aerospace Award, and for next year we will sponsor the Olsen-Wegner Outstanding Aeromedical Technician Award. It was a great honor to present Gen Bruce Green the George E. Schafer Award for his dedication to the specialty of Aerospace Medicine throughout his career. Now for a summary of what is in this FlightLines. Col Alden Hilton has authored an article on the many significant changes confronting Aerospace Medicine and what Air Staff has done to match policy and personnel to confront the myriad of changes. Although Aerospace Medicine is an operationally challenged career field, we have not had a better time to impact world events than we currently have. There are so many operational, clinical, and developing issues in Aerospace Medicine that we have opportunities wherever we look. Col Steve Barnes' article on the Air Force Materiel Command and the two following articles on pre-RAM training by Lt Col Michael Hodges and Maj Sanjay Gogate highlight some of the methods used by the School of Aerospace Medicine and our university partners to prepare RAMs for careers in Aerospace Medicine. Additionally, Col Len Profenna and Col Gerry Brower's article on the Air Force Undersea and Hyperbarics Medicine Fellowship reflects how this training program is utilized to address some of the issues I mentioned previously (i.e., F-22 hypoxia). Lt Col Laura Brodhag and Maj Patricia Pankey authored a very nice article entitled "Obstructive Sleep Apnea in the Military Aviator." We don't often get journal-type submissions to FlightLines, but this is a great addition and we welcome more (as long they are related to aeromedical operational issues and not a basic research rat study).
[Show abstract][Hide abstract] ABSTRACT: The purpose of this article is to discuss the anesthetic considerations of obstructive sleep apnea (OSA) patients undergoing ambulatory surgery and the current recommendations based on recent evidence.
It is documented that 75% of patients with high propensity for OSA were not diagnosed prior to ambulatory surgery. An OSA screening questionnaire, the STOP-Bang questionnaire, may be useful to identify patients who have high risk of OSA. Patients with mild-to-moderate OSA with optimized comorbid condition should be able to safely undergo ambulatory surgery. However, severe OSA patients without optimized comorbid conditions are not ideal candidates for ambulatory surgery. Recently, transient oxygen desaturation in postanesthetic care unit has been described in OSA patients with no further increase in unanticipated hospital admission after ambulatory surgery. However, OSA patients undergoing ambulatory upper airway surgery often have lower threshold for hospitalization. A majority of OSA patients are undergoing ambulatory surgery safely. Careful choice of OSA patients, the use of short-acting anesthetic agents with increased perioperative vigilance helps to reduce the adverse cardiopulmonary events in the ambulatory anesthetic settings. Facilities for inpatient admission of OSA patients when necessary should be available. It may not be safe to discharge severe OSA patients who require narcotic analgesics in the postoperative period.
The recent publications indicated that the majority of OSA patients may be done as ambulatory surgical patients with few adverse events. However, it may not be safe to do patients with severe OSA requiring postoperative narcotics as ambulatory surgical patients.
Current opinion in anaesthesiology 07/2011; 24(6):605-11. DOI:10.1097/ACO.0b013e32834a10c7 · 1.98 Impact Factor
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