Obstructive sleep apnea in adult ambulatory anesthesia: navigating guidelines and evidence for safe home discharge

Ambulatory anesthesia for surgical and interventional procedures is increasingly common. In this Continuing Professional Development module, we present a postoperative risk prediction and care model framework for patients with obstructive sleep apnea (OSA) undergoing ambulatory anesthesia.

Ensuring that patients with OSA are safe to be discharged home on the same day as their procedure requires careful consideration of multiple relevant risk factors. Preoperative patient assessment for the prediction of postprocedural complications is based on OSA status and severity, coexisting cardiorespiratory disease severity, the expected physiologic impacts of anesthesia and surgery, and anticipated opioid requirements. Patients with moderate or severe OSA are more likely to be candidates for ambulatory surgery if the planned procedure is peripheral or superficial, is conducted under local or regional anesthesia, and postoperative pain is predominantly managed with nonopioid analgesia. Patients with OSA undergoing sedation may be at an increased postoperative risk if long-acting sedative medications are used and the monitored recovery time is inadequate. Regardless of the procedure, a comprehensive postanesthesia care unit assessment strategy is essential. Patients must be free of postoperative cardiorespiratory indicators of OSA-related complications, have their pain managed with, at most, low-dose oral opioids, and maintain an adequate oxygen saturation while breathing room air. Patients who fail to meet these standards should not be discharged and should stay in a monitored environment overnight.

Obstructive sleep apnea is associated with increased rates of perioperative complications and an increased risk of morbidity and mortality. Perioperative management guidelines and recommendations have been developed for patients with OSA, but higher-quality evidence-based guidance is needed. The framework presented in this Continuing Professional Development module is a practical guide to the daily dilemma practitioners face in safely managing patients with OSA undergoing ambulatory anesthesia.