[Is the observation of patients with sleep-apnea-syndrome after surgery of the upper airway in an intensive care unit generally necessary?].
BACKGROUND
Although it is known that after surgery of the nose and/or the paranasal sinuses serious complications can arise for patients suffering from Sleep-Apnea-Syndrome (SAS), there exists no general recommendation for postoperative care of these patients. This retrospective analysis is dealing with the question whether it is generally necessary to observe SAS-patients after nasal surgery including intubation in an Intensive Care Unit (ICU).


METHODS
24 Patients of the ORL-Dept., Marienkrankenhaus Hamburg, suffering from SAS underwent surgery of the nose, the paranasal sinuses and/or the pharynx including total intravenous anesthesia (TIVA) during the period of 1. 10. 2000 until 1. 5. 2004. SAS was diagnosed in 6 cases due to defined clinical criteria and in 18 cases due to the polysomnographic findings in the sleeping laboratory's examination. All patients were observed postoperatively for one night in an ICU. The anesthesia protocol and the intensive care curve of each patient were systematically evaluated with special regard of the following parameters: Risk factors (Body Mass Index; other diseases, ASA-classification), premedication drugs, duration of the surgery, drugs for pain relief, lowest O2-saturation of blood, lowest heartrate, highest systolic blood pressure, adverse effects, intensive care interventions.


RESULTS
Intensive care interventions were never needed. 2 patients received a low dosage of oxygeninsufflation via a face mask, in 5 cases calcium-antagonist drugs were administered due to high blood pressure and in 1 case Metamizole administration was necessary due to high temperatures. An accompanying bradycardia of the same patient was treated by administration of Atropine. The lower average O2-saturation was 93.6 +/- 1.7 % (Minimum value: 89 %). The maximum systolic blood pressure was 165.8 +/- 21.2 mm Hg and the lowest average heart rate was 65.4 +/- 13.2 bpm.


CONCLUSIONS
Patients suffering from a mild to moderate SAS do not need a general postoperative surveillance in an ICU if the chosen form of anesthesia is considered concerning this sickness.
Kehrl
W
W
Klinik und Ambulatorium für HNO-Krankheiten, Kopf-, Hals- und Plastische Gesichtschirurgie, Marienkrankenhaus Hamburg. kehrl.hno@marienkrankenhaus.org
Schottke-Hennings
H
H
Offergeld
Ch
Ch
Grundmann
T
T
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D010160:Palate, Soft / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis