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Spotlight

 




 


Anaesthesia


   

 




Sleep
Apnea

   

  • Ostermeier
    AM, Roizen MF, Hautkappe M, et al

    Three
    Sudden Postoperative Respiratory Arrests Associated
    with Epidural Opiods in Patients with Sleep Apnea


    Anesth
    Analg 85: 452-460, 1997


     

    Three
    patients with sleep apnea [ 2 reported in this
    article] who had sudden postoperative arrests
    associated with epidural opiods were reported.

     

    Case
    1 was a woman, 41, operated for right hip revision
    arthroplasty. She
    had history of sleep apnea, morbid obesity and
    juvenile rheumatoid arthritis.
    She received epidural analgesia consisting of
    0.06% bupivacaine, 7 mL/hour, plus fentanyl, 10
    micro-g/mL after surgery.
    Two days after surgery she was found to be
    unresponsive, with slow, deep respirations, an
    arterial blood pressure of 84/40 mm Hg., and a heart
    rate of 70/min. Later
    in the day, cardiac arrest occurred 3 times and she
    died.  Autopsy
    revealed no cause of death.

     

    Case
    2 was a man, 66, operated for bilateral knee
    arthroplasty. He
    had history of sleep apnea, hypertension, and
    deviated nasal septum.
    He had epidural anesthesia, and during
    recovery he was given epidural infusion of 0.06%
    bupivacaine, 7 mL/hour, and fentanyl, 10 micro-g/mL.
    On the third postoperative day, he was found to be
    unresponsive and could not be resuscitated.

      

    The
    authors conclude that patients with sleep apnea
    syndrome are at particularly high risk of
    postoperative respiratory depression from any mode
    of analgesic therapy, and that guidelines for
    management of such patients need to be created. 
    Continuous nasal positive airway pressure
    before and after surgery, for 24 to 48 hours has
    been recommended. Tracheal
    extubation should be attempted only after the
    patient is fully conscious and the upper airway is
    patent. Corticoid
    administration must be considered to reduce airway
    edema if present. Such
    patients go into sudden respiratory arrest without
    any warning and need to be constantly monitored.

       




 

 

Specialty Spotlight

 

 
Anaesthesia
   

 

Sleep Apnea
   

  • Ostermeier AM, Roizen MF, Hautkappe M, et al
    Three Sudden Postoperative Respiratory Arrests Associated with Epidural Opiods in Patients with Sleep Apnea
    Anesth Analg 85: 452-460, 1997
     
    Three patients with sleep apnea [ 2 reported in this article] who had sudden postoperative arrests associated with epidural opiods were reported.
     
    Case 1 was a woman, 41, operated for right hip revision arthroplasty. She had history of sleep apnea, morbid obesity and juvenile rheumatoid arthritis. She received epidural analgesia consisting of 0.06% bupivacaine, 7 mL/hour, plus fentanyl, 10 micro-g/mL after surgery. Two days after surgery she was found to be unresponsive, with slow, deep respirations, an arterial blood pressure of 84/40 mm Hg., and a heart rate of 70/min. Later in the day, cardiac arrest occurred 3 times and she died.  Autopsy revealed no cause of death.
     
    Case 2 was a man, 66, operated for bilateral knee arthroplasty. He had history of sleep apnea, hypertension, and deviated nasal septum. He had epidural anesthesia, and during recovery he was given epidural infusion of 0.06% bupivacaine, 7 mL/hour, and fentanyl, 10 micro-g/mL. On the third postoperative day, he was found to be unresponsive and could not be resuscitated.
      
    The authors conclude that patients with sleep apnea syndrome are at particularly high risk of postoperative respiratory depression from any mode of analgesic therapy, and that guidelines for management of such patients need to be created.  Continuous nasal positive airway pressure before and after surgery, for 24 to 48 hours has been recommended. Tracheal extubation should be attempted only after the patient is fully conscious and the upper airway is patent. Corticoid administration must be considered to reduce airway edema if present. Such patients go into sudden respiratory arrest without any warning and need to be constantly monitored.
       

 

By |2022-07-20T16:44:11+00:00July 20, 2022|Uncategorized|Comments Off on Sleep Apnea

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