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Wednesday, December 4, 2013
Sleep Apena Anesthesia Danger?
I have sleep apena and read that general anesthesia poses more risk for those with sleep apena. Should the anesthesologist be aware of my condition prior to surgery? What extra precautions should be taken by the anesthesologist? I am living in a foreign country and want to make sure everyone is aware if I were to ever need surgery.
If you have obstructive sleep apnea (OSA) your anesthesiologist should very definitely be made aware that you have this condition. OSA is exacerbated by the lingering effects of general anesthesia during the recovery phase. In other words, your apnea spells (breathing pauses) are likely to become more frequent and more severe, after general anesthesia. This is especially true if the pain-killer drugs known as opioids or narcotics - like morphine, meperidine, and hydromorphone - are used. Severe OSA causes low oxygen levels in the blood, which affects the heart, brain, and pulmonary circulation. In the worst case scenario, OSA when combined with opioids can even lead to a fatal respiratory (breathing) arrest
Patients with OSA are more often difficult to intubate (place a breathing tube) than other patients. Other considerations for anesthesia correspond with whatever other conditions you have, that might be associated with obesity and/or OSA, such as high blood pressure, diabetes, heart disease, heart rhythm disturbances, etc.
If you have severe OSA then you should be carefully monitored in hospital after your surgery at least overnight, be given supplemental oxygen, and, ideally, pain relief that minimizes or avoids opioid medication. Sometimes a short stay in ICU is a good idea. Patients who use CPAP or BiPAP airway devices that splint the airway open to decrease apneic spells, should continue to use their device. Patients who have confirmed OSA and do not yet have a recommended CPAP or BiPAP device might want to delay surgery in order to acquire and begin using their device. Of course, these devices are not the only treatment for this condition. OSA is usually, but not always associated with obesity, so weight loss can help. Occasionally surgery on the airway can help too.
OSA is not as prevalent in other countries as it is in the USA, so your doctors might want to read the latest guidelines on OSA published by the American Society of Anesthesiologists last year, which can be found in the link below.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University