阻塞性睡眠呼吸暂停.ppt

CAUSES OF OSA:OBESITY BMI 35MICROGNATHIA&RETROGNATHIA NECK 17”(MEN),16”(WOMEN)NASAL OBSTRUCTION BIG TONSILS/LARGE TONGUE1、Is there is a history or observation of apnea or snoring with hypopnea(sleep disordered breathing SDB)2、Is there a history or observation of arousal from sleep(extremity movement,turning,vocalization发声,snorting鼻息声)3、Is there a history or observation of daytime somnolence(easily falls asleep during the quiet times of the day)Mild(1):obese,snores most of the time they sleep,not observed apnea or arousals,not falls asleep easily daytime.Severe(3)：obese morbidly,snore all night,observed apneas&arousals frequently,falls asleep during most of the quiet times during the day.Moderate（2）：between these two extremesI of A/S：0：superficial surgery+local anesthesia or peripheral nerve block+not sedation1:superficial surgery+local anesthesia or peripheral nerve block+moderate sedation2:superficial surgery+general anesthesia 3:major cavitary or airway surgery+general anesthesiaPOR:postoperative opioid requirementNo POR,Low Dose Oral POR,Moderate Dose Oral PORAnd a High Dose of POR(0 score 3score)PERIOPERATIVE MANAGEMENT OF OSA：FACILITY OUTPATIENT&INPATIENTRISK=4 ANY FACILITY SHOULD HAVE 1 EMERGENCY DIFFICULT AIRWAY EQUIPMENT 2 RESP CARE RX=NEBULIZES,CPAP,VENTILATORS3 PORTABLE CHEST X-RAY&ECG 4 CLINICAL LAB FOR ABGS,ELECTROLYTES,HGB/HCTPERIOPERATIVE MANAGEMENT OF OSA PATIENTS:CONSULTANTS AGREEMENTS:PREOPERATIVE&INTRAOPERATIVEPreoperative preparation with cpap or bipap improves physical status.The airway management in general anesthesia,follow ASA Difficult Airway Guideline.Moderate/deep sedation-use CO2 monitoringGeneral anesthesia+secure airway deep sedation+no airwayBe extubated when fully awake in the upright position&reversal of neuromuscular blockade.Spinal/Epidural Anesthesia in peripheral surgery GA&/or OpioidsCPAP or NIPPV should be administered as soon as possible after surgery to patients with OSA who were receiving it preoperatively.Continuous bedside SpO2 without continuous observation does not provide the same level of safety.