title: Obstructive sleep apnea surgery: risk management and complications.
abstract: Hypoxemia, hypertension, airway obstruction, and death have been associated with surgery for obstructive sleep apnea syndrome (OSAS). Patient analysis was undertaken to identify potential factors that could affect risk-management outcome.
  
  
  
  One hundred eighty-two consecutively treated patients with OSAS undergoing 210 procedures were evaluated. Fifty-four factors were analyzed.
  
  
  
  Group characteristics included a mean age of 48.2 years, a mean respiratory disturbance index of 42.3, and a mean low oxyhemoglobin desaturation (LSAT) of 77.5%. Surgery included a combination of uvulopalatopharyngoplasty (162 patients; 77%) and maxillofacial procedures (173 patients; 82%). Patients with a respiratory disturbance index greater than 40 and an LSAT less than 80% (117 patients; 64%) were maintained on nasal continuous positive airway pressure. Thirty-nine patients (18.6% had difficult intubations. There was a positive correlation (p > 0.001) of difficult intubations, neck circumference (> 45.6 cm) and skeletal deficiency (Sella-Nasion-Point B < 75 degrees). All tubes were removed with the patient awake in the operating room with two transient episodes of airway obstruction. One hundred forty-eight of the patients (70.5%) required postoperative intravenous antihypertensive medications. Patients with a preoperative history of hypertension had a significantly increased risk (p > 0.01) of requiring intraoperative and postoperative intravenous antihypertensive medications. The mean hospital stay was 2.2 days (SD +/- 0.9). Analgesia was achieved with intravenous morphine sulfate or meperidine HCl (intensive care unit) and oral oxycodone (non-intensive care unit). There were no significant oxyhemoglobin desaturations, irrespective of severity of OSAS or obesity (mean LSAT day 1, 94.8% (SD +/- 2.4); mean LSAT day 2, 95.5% (SD +/- 1.6)). Complications included postoperative bleeding (n = 4), infection (n = 5), seroma (n = 3), arrhythmia (n = 4), angina (n = 1), and loss of skeletal fixation (n = 1).
  
  
  
  Intraoperative airway risks can be reduced by use of fiberoptic intubation in patients with increased neck circumference and skeletal deficiency. Patients with OSAS are at a significantly increased risk for hypertension. Nasal continuous positive airway pressure eliminated the postoperative risk of hypoxemia, which allowed the use of adequate parenteral or oral analgesics.
authors.affiliation: Stanford University Sleep Disorders Clinic and Research Center, California, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Riley
authors.forename: N B
authors.initials: NB
authors.lastname: Powell
authors.forename: C
authors.initials: C
authors.lastname: Guilleminault
authors.forename: R
authors.initials: R
authors.lastname: Pelayo
authors.forename: R J
authors.initials: RJ
authors.lastname: Troell
authors.forename: K K
authors.initials: KK
authors.lastname: Li
mesh_terms: D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010108:Oxyhemoglobins / Q000032:analysis; D010149:Postoperative Pain / Q000188:drug therapy; D011182:Postoperative Care; D011183:Postoperative Complications; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000601:surgery*
chemical_list: D010108:Oxyhemoglobins