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Perioperative CPAP

Cara C Cockerill, Christopher D Frisch, Sarah E Rein, Laura J Orvidas
OBJECTIVE: Children with Down syndrome have a higher incidence of upper airway obstruction and laryngomalacia. We sought to determine outcomes of supraglottoplasty in this patient population. METHODS: A retrospective chart review was performed from January 2000 through January 2014. Children (n = 18) at our institution with the diagnosis of Down syndrome who underwent supraglottoplasty were included. We reviewed patient characteristics, preoperative findings, and surgical outcomes (stridor, feeding problems, respiratory distress, weight, sleep apnea, and tracheostomy or feeding tube dependence)...
August 2016: International Journal of Pediatric Otorhinolaryngology
Shruti Redhu, Prabhakar Suman Prakash, Virendra Jain, Hari Hara Dash
Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP) therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery...
June 2016: Indian Journal of Anaesthesia
Mervi Hannele Javanainen, Tom Scheinin, Harri Mustonen, Marja Leivonen
: The current understanding of prophylaxis of pulmonary complications in bariatric surgery is weak. PURPOSE: The aim of this study was to observe how changes in perioperative and postoperative treatments affect the incidence of pulmonary complications in bariatric patients. MATERIALS: This is a retrospective clinical study of 400 consecutive bariatric patients. The patients, who either underwent a sleeve gastrectomy or a Roux-en-Y gastric bypass, were divided consecutively into four subgroups with different approaches to perioperative treatment...
May 24, 2016: Obesity Surgery
Wing Tai Kong, Shawn Chopra, Michael Kopf, Carlos Morales, Shahzad Khan, Keith Zuccala, Laura Choi, John Chronakos
BACKGROUND: The use of continuous positive airway pressure (CPAP) perioperatively in bariatric surgery patients with obstructive sleep apnea (OSA) has been controversial. Although studies have demonstrated that CPAP use is safe in bariatric patients, prior studies have not shown improvement in outcomes in these patients. METHODS: A retrospective review of patients who underwent bariatric surgery from 2005 to 2009 was performed. All patients underwent polysomnography preoperatively...
May 20, 2016: Obesity Surgery
Akshay Dwarakanath, Vinod Palissery, Mark W Elliott
Obstructive sleep apnoea (OSA) has implications perioperatively. We compared the prevalence of OSA and outcome with continuous positive airway pressure (CPAP) in patients diagnosed through preoperative screening and following referrals from other clinicians.Among 1412 patients (62% males) the prevalence of OSA, Epworth Sleepiness Score (ESS), the number referred for CPAP, and short and longer term use of CPAP were compared between the two groups.The prevalence of OSA was similar (62% versus 58%). There were differences in mean±sd age (61±16 versus 55±13 years; p<0...
July 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Kate Reed, Martino F Pengo, Joerg Steier
BACKGROUND: Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing frequently associated with obesity. Obese subjects undergoing elective surgical procedures with general anesthesia are potentially at risk if this condition is not identified. Our aim was to assess the prevalence of bariatric patients with undiagnosed OSA following pre-operative assessment and who could benefit from peri-procedural respiratory management. METHODS: Patients who were referred for prospective bariatric surgery were screened using the STOP-BANG questionnaire...
February 2016: Journal of Thoracic Disease
Ligia Cordovani, Frances Chung, Geneviève Germain, Kim Turner, Alexis F Turgeon, Richard Hall, Peter C Gay, Gregory L Bryson, Peter T Choi
INTRODUCTION: Obstructive sleep apnea (OSA) may increase the incidence of postoperative complications when undiagnosed. The purpose of this study was to evaluate the perspectives of Canadian anesthesiologists regarding the perioperative management of patients with diagnosed or suspected OSA. METHODS: This study was conducted as a survey of Canadian anesthesiologists using a self-administered scenario-based questionnaire. We initially mailed the survey questionnaire and then mailed it again to non-respondents six weeks later...
January 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Frances Chung, Mahesh Nagappa, Mandeep Singh, Babak Mokhlesi
OSA is a commonly encountered comorbid condition in surgical patients. The risk of cardiopulmonary complications is increased by two to threefold with OSA. Among the different treatment options for OSA, CPAP is an efficacious modality. This review examines the evidence regarding the use of CPAP in the preoperative and postoperative periods in surgical patients with diagnosed and undiagnosed OSA.
February 2016: Chest
L Edmark, E Östberg, H Scheer, W Wallquist, G Hedenstierna, H Zetterström
BACKGROUND: Venous admixture from atelectasis and airway closure impedes oxygenation during general anaesthesia. We tested the hypothesis that continuous positive airway pressure (CPAP) during pre-oxygenation and reduced fraction of inspiratory oxygen (FIO2 ) during emergence from anaesthesia can improve oxygenation in patients with obesity undergoing laparoscopic surgery. METHODS: In the intervention group (n = 20, median BMI 41.9), a CPAP of 10 cmH2 O was used during pre-oxygenation and induction of anaesthesia, but no CPAP was used in the control group (n = 20, median BMI 38...
January 2016: Acta Anaesthesiologica Scandinavica
Carlos Ferrando, Marina Soro, Jaume Canet, Ma Carmen Unzueta, Fernando Suárez, Julián Librero, Salvador Peiró, Alicia Llombart, Carlos Delgado, Irene León, Lucas Rovira, Fernando Ramasco, Manuel Granell, César Aldecoa, Oscar Diaz, Jaume Balust, Ignacio Garutti, Manuel de la Matta, Alberto Pensado, Rafael Gonzalez, M Eugenia Durán, Lucia Gallego, Santiago García Del Valle, Francisco J Redondo, Pedro Diaz, David Pestaña, Aurelio Rodríguez, Javier Aguirre, Jose M García, Javier García, Elena Espinosa, Pedro Charco, Jose Navarro, Clara Rodríguez, Gerardo Tusman, Francisco Javier Belda
BACKGROUND: Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach...
2015: Trials
Mahesh Nagappa, Babak Mokhlesi, Jean Wong, David T Wong, Roop Kaw, Frances Chung
BACKGROUND: Obstructive sleep apnea (OSA) is a commonly encountered comorbid condition in patients undergoing surgery and is associated with a greater risk of postoperative adverse events. Our objective in this review was to investigate the effectiveness of continuous positive airway pressure (CPAP) in reducing the risk of postoperative adverse events in patients with OSA undergoing surgery, the perioperative Apnea-Hypopnea Index (AHI), and the hospital length of stay (LOS). METHODS: We performed a systematic search of the literature databases...
May 2015: Anesthesia and Analgesia
Ashish C Sinha, Preet Mohinder Singh
Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures...
May 2015: Obesity Surgery
Noriaki Komayama, Kotoe Kamata, Takashi Maruyama, Masayuki Nitta, Yoshihiro Muragaki, Makoto Ozaki
Both obesity (BMI over 30) and SAS are risks for Supper airway maintenance. We report an obese patient (BMI 33.5) with SAS who underwent awake craniotomy. Weight reduction was instructed 1 month before the operation, and the patient lost enough weight to use intraoperative MRI. Under general anesthesia, surgical pads containing 2% lidocaine with adrenaline were inserted into the nasal cavities. The patient's airway S was secured by i-gel® until dura was opened. A nasal airway was then inserted to confirm the upper airway patency and anesthetics were terminated The patient regained consciousness and started respiration...
October 2014: Masui. the Japanese Journal of Anesthesiology
Hiromi Kako, Anatoliy Goykhman, Archana S Ramesh, Senthil G Krishna, Joseph D Tobias
BACKGROUND: With the introduction of redesigned cuffed endotracheal tubes (ETTs), there has been an increasing trend toward their use in pediatric patients. Despite improvements in design, an unintended and prolonged hyperinflation of the cuff can compromise tracheal mucosal perfusion. The current study prospectively monitors changes in intracuff pressure continuously in pediatric patients undergoing prolonged surgical procedures. METHODS: The study was conducted on pediatric patients who were scheduled to undergo prolonged surgical procedures (more than 4h) with a cuffed ETT...
January 2015: International Journal of Pediatric Otorhinolaryngology
E Deflandre, S Degey, V Bonhomme, A F Donneau, R Poirrier, J F Brichant, P Hans
BACKGROUND: Obstructive Sleep Apnea (OSA) increases the perioperative risk of complications. Chronic use of Continuous Positive Airway Pressure (CPAP) by patients decreases the importance of comorbidities caused by the OSA. However, many patients do not adhere to the treatment. Given the postoperative complications, it is important for the anesthesiologist to identify non-adherent patients. This prospective study was designed to identify factors that would predict patient adherence. METHODS: Ninety patients who were treated by CPAP for more than one year were recruited...
September 2015: Minerva Anestesiologica
Rahul G Baijal, Sudha A Bidani, Charles G Minard, Mehernoor F Watcha
BACKGROUND: Perioperative respiratory complications after adenotonsillectomy (T&A) are common and have been described to occur more frequently in children below 3 years of age, those with cranio-facial abnormalities, Down syndrome, obstructive sleep apnea, morbid obesity, and failure to thrive. AIMS: To investigate the association between awake vs deep tracheal extubation and perioperative respiratory conditions. RESULTS: The primary outcome was any perioperative respiratory complication...
April 2015: Paediatric Anaesthesia
Jonathan D Mathers, Thomas M Breen, Jonathan H Smith
OBJECTIVES: To perform a retrospective, anesthesia case note review of patients with Fraser syndrome. AIM: To identify the perioperative and postoperative anesthetic management and complications in this patient group. BACKGROUND: Fraser syndrome is a rare, autosomal recessively inherited disorder characterized by cryptophthalmos, cutaneous syndactyly, and ambiguous genitalia. It also has variable association with cardiac, laryngeal, tracheal, and gastrointestinal abnormalities...
December 2014: Paediatric Anaesthesia
Daigo Sogo, Tadashi Nakazawa, Wataru Nishio, Kunio Fukukita
General anesthesia was successfully performed in an 86-year-old woman with severe tracheobronchomalacia Tracheobronchomalacia in adult is a very rare disease, characterized by weakness of the trachea and bronchi, causing luminal narrowing during expiration. The patient had laparoscopic cholecystectomy. We used propofol, remifentanil, and rocuronium for induction of anesthesia. For maintenance of anesthesia, oxygen, air, propofol, fentanyl, and remifentanil were used. After the end of operation, we used sugammadex to reverse neuromuscular blockade by rocuronium...
August 2014: Masui. the Japanese Journal of Anesthesiology
Eiman Rahimi, Ramamani Mariappan, Suresh Tharmaradinam, Pirjo Manninen, Lashmi Venkatraghavan
BACKGROUND AND AIMS: Patients with endocrine diseases such as acromegaly and Cushing's disease have a high prevalence of obstructive sleep apnea (OSA). There is controversy regarding the use of continuous positive airway pressure (CPAP) following transsphenoidal surgery. The aim of this study was to compare the perioperative management and complications, in patients with or without OSA undergoing transsphenoidal surgery. MATERIALS AND METHODS: After Research Ethics Board approval, we retrospectively reviewed the charts of all patients who underwent transsphenoidal surgery in our institution from 2006 to 2011...
July 2014: Journal of Anaesthesiology, Clinical Pharmacology
Monika A Proczko, Pieter S Stepaniak, Marcel de Quelerij, Floor Haak van der Lely, J Frans Smulders, Lukasz Kaska, Mohammed A Soliman Hamad
BACKGROUND: In patients undergoing surgical interventions under general anesthesia, obstructive sleep apnea syndrome (OSA) can cause serious perioperative cardiovascular or respiratory complications leading to fatal consequences, even sudden death. In this study we test the hypothesis that morbidly obese patients diagnosed by a polysomnography test and using continuous positive airway pressure (CPAP) therapy have fewer and less severe perioperative complications and a shorter hospital stay than patients who have a medical history that meets at least three STOP-Bang criteria and are not using CPAP therapy...
December 2014: Journal of Anesthesia
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