Nicolai Goettel MD, Eiman Rahimi MD, Ramamani Mariappan MD, Pirjo Manninen MD, Lashmi Venkatraghavan MD. Department of Anesthesia, University of ...
Perioperative Management of Obstructive Sleep Apnea in Transsphenoidal Neurosurgery Nicolai Goettel MD, Eiman Rahimi MD, Ramamani Mariappan MD, Pirjo Manninen MD, Lashmi Venkatraghavan MD Department of Anesthesia, University of Toronto, University Health Network , Toronto Western Hospital, Toronto, ON, Canada Introduction A
high incidence of Obstructive Sleep Apnea (OSA) has been reported among patients undergoing transsphenoidal neurosurgery [1]. Continuous Positive Airway Pressure (CPAP) is the mainstay of treatment in patients with OSA. However, the use of conventional or nasal CPAP is contraindicated in patients after transsphenoidal surgery because of the risk of pneumocephalus [2].
Results (2) Obstructive
Results for patient subgroup with OSA (n=40): Distribution of pathologies in OSA patients are shown in figure 2.
Intraoperative complications: 3 patients (7.5%) presented with difficult bag mask ventilation. 3 patients (7.5%) needed >1 intubation attempt. No other intraoperative complications were noted. All patients were extubated at the end of surgery.
Postoperative destination: Purpose The purpose of this study was to review the perioperative management of OSA in patients undergoing endoscopic transsphenoidal neurosurgery (hypophysectomy) in our institution, since there are no guidelines or consensus in this regard.
Discussion
Figure 3: Patients assessed for OSA
38 patients (95%) PACU Neurocritical Care Unit (NCCU). 2 patients (5%) Intensive care unit (ICU). Average length of NCCU/ICU stay: 1.7 days in OSA patients vs. 1.3 days in non-OSA patients. Average length of hospital stay was 2.7 days in both OSA patients and non-OSA patients.
Mean dose of opioid analgesics in PACU/NCCU: Conclusion
Fentanyl iv 54 μg. Morphine iv 2.6 mg. Codeine po 52 mg.
Methods After
institutional REB approval (patient consent not required), we retrospectively reviewed all medical records of patients who were scheduled for transsphenoidal surgery at the Toronto Western Hospital, University Health Network from June 2006 to May 2011. We recorded and analyzed data for demographics, diagnosis, history of OSA, airway management, and all respiratory complications.
Postoperative respiratory outcomes: Supplemental oxygen was administered to all patients during the first 24 hours. 10 patients (25%) presented with hypoxemia (SpO2
