MetroHealthAnesthesiaSleep Apnea Syndromes


Sleep Apnea = cessation of airflow at mouth for > 10 seconds while sleeping

Causes

  • central apnea
    • loss of CNS drive
    • Ondines's curse
  • obstructive (mechanical)

Manifestations

  • daytime sleepiness
  • history of loud snoring
  • obesity
  • hypertension
  • arterial hypoxemia
  • polycythemia
  • hypercarbia
  • cor pulmonale

Surgical treatment

  • uvulopalatophyaryngoplasty (UPP)
  • genioglossal advancement
  • maxillo-mandibular advancement
  • tracheostomy

Anesthesia

  • BEWARE: exquisite sensitivity to CNS depressants leading to upper airway obstruction, hypoventilation
  • avoid preop sedation
  • minimize use of opioids (including neuraxial opioids)
  • use short acting medications
  • consider role of awake (fiberoptic) intubation
  • delay extubation until patient is awake
  • consider regional anesthesia/analgesia
  • consider postoperative local anesthetics, nonopioid analgesics
  • postop, monitor respirations, SpO2



Send Comments to Greg Gordon MD, gjg@po.cwru.edu
Department of Anesthesiology
The MetroHealth System
2500 MetroHealth Drive
Cleveland, Ohio 44109-1998
Phone: (216) 778-4801
Last updated: