Anesthetic management of a patient with obstructive sleep apnea syndrome and difficult airway access

Patients with the obstructive sleep apnea syndrome (OSAS) are predisposed to respiratory complications under the influence of sedative and anesthetic drugs because of these drugs' alternation of respiratory control with a tendency for upper airway collapse. Additional difficulties for airway management during anesthesia may arise if fixed anatomic obstacles block the upper airway. We present a case of a patient with OSAS scheduled for general anesthesia for nasal polypectomy and correction of a deviated septum. Preoperative evaluation revealed several factors known to be associated with difficult intubation and ventilation: nasal obstruction, maxillofacial malformation (micrognathia), reduced temporomandibular joint mobility, and obesity. An individualized strategy of airway management based on published standards was developed and successfully applied. It involved fiberoptic guided intubation through a laryngeal mask airway. This case illustrates the management of patients with OSAS and additional conditions that reduce upper airway patency.