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Obstructive sleep apnea, continuous positive airway pressure, and surgery
N B Powell1, R W Riley, C Guilleminault
1Stanford University Hospital, CA.
Summary
Nasal continuous positive airway pressure (CPAP) can be a safe alternative to tracheostomy for severe obstructive sleep apnea (OSA) patients undergoing upper airway surgery. This approach effectively maintains oxygen saturation post-surgery.
Area of Science:
- Otolaryngology
- Sleep Medicine
- Anesthesiology
Background:
- Obstructive sleep apnea (OSA) patients undergoing upper airway surgery risk postoperative desaturation.
- Severe OSA patients historically considered for protective tracheostomy due to these risks.
- Factors like obesity and edema can exacerbate postoperative desaturation.
Purpose of the Study:
- To evaluate nasal continuous positive airway pressure (CPAP) as an alternative to tracheostomy for severe OSA patients post-upper airway surgery.
- To assess CPAP's efficacy in maintaining airway patency and hemoglobin saturation.
Main Methods:
- Ten severe OSA patients undergoing elective upper airway surgery were treated with immediate postoperative nasal CPAP.
- Postoperative monitoring included continuous pulse oximetry, cardiac activity, and intermittent arterial blood gases.
- Preoperative and postoperative oxygen saturation levels were compared.
Main Results:
- All ten patients maintained adequate oxygen saturation (SaO2 ≥ 90%) post-surgery with CPAP.
- Mean postoperative SaO2 was 93% on room air.
- Preoperatively, patients exhibited severe desaturation with a mean nadir SaO2 of 51.5%.
Conclusions:
- Nasal CPAP is a viable alternative to protective tracheostomy for selected severe OSA patients undergoing upper airway surgery.
- CPAP effectively supports airway patency and maintains hemoglobin oxygen saturation in the immediate postoperative period.