Obstructive sleep apnea (OSA) is a risk factor for perioperative complications but data on anesthesia regimen are scarce.
In patients with established or strongly suspected OSA, we assessed in a prospective, randomized design the effects on nocturnal apnea-hypopnea-index (AHI) and oxygen saturation (SpO2) of propofol/remifentanil or sevoflurane/remifentanil based anesthesia. Patients were selected by a history for OSA and / or a positive STOP – questionnaire and received general anesthesia using remifentanil (12 μg/kg/h) combined either with propofol (4-6 mg/kg/h, n = 27) or sevoflurane (approx. 2.2 vol% endtidal, n = 27). AHI and SpO2 were measured during the nights before and after anesthesia.
There were no differences in AHI between anesthetic regimens nor between the pre- and postoperative nights (propofol: 8.6 h− 1 (median, CI: 3.6–21.9) vs. 7.9 h− 1 (1.8–28.8); p = 0.97; sevoflurane: 3.8 h− 1 (1.8–7.3) vs. 2.9 h− 1 (1.2–9.5); p = 0.85). Postoperative minimum SpO2 (propofol: 80.7% ± 4.6, sevoflurane: 81.6 ± 4.6) did not differ from their respective preoperative baselines (propofol: 79.6% ± 6.5; p = 0.26, sevoflurane: 80.8% ± 5.2; p = 0.39). Even in patients with a preanesthetic AHI > 15, nocturnal AHI remained unchanged postoperatively.
Thus, in a cohort of patients with suspected or confirmed OSA undergoing surgery of moderate duration and severity neither the volatile agent sevoflurane nor the intravenous anesthetic propofol altered nocturnal AHI or oxygen saturation, when combined with the short acting opioid remifentanil.
German Clinical Trials Register, DRKS00005824 retrospectively registered on 03/12/2014.
Liao P, Yegneswaran B, Vairavanathan S, Zilberman P, Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study. Can J Anesth/J Can Anesth. 2009;56:819–28. CrossRef
Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after bariatric surgery: analysis of the Nationwide inpatient sample. Obes Surg Springer US. 2013;23:1842–51. CrossRef
Mokhlesi B, Hovda MD, Vekhter B, Arora VM, Chung F, Meltzer DO. Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the Nationwide inpatient sample. Chest American College of Chest Physicians. 2013;144:903–14.
American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2014:268–86.
Silverstein JH, Connis RT, Fillmore RB, Hunt SE, Apfelbaum JL, Barlow JC, et al. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic care. Anesthesiology. 2013:291–307.
Chung F, Liao P, Yegneswaran B, Shapiro CM, Kang W. Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology. 2013;120:287–98. CrossRef
Pan Y, Wang W, Wang K-S. Associations of Alcohol Consumption and Chronic Diseases With Sleep Apnea Among US Adults. Int J High Risk Behav Addict. Kowsar. 2014;3:e19088.
Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc American Thoracic Society. 2008;5:136–43. CrossRef
- Perioperative incidence of airway obstructive and hypoxemic events in patients with confirmed or suspected sleep apnea - a prospective, randomized pilot study comparing propofol/remifentanil and sevoflurane/remifentanil anesthesia
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