title: Do Patients with Obstructive Sleep Apnea have an Increased Risk of Desaturation During Induction of Anesthesia for Weight Loss Surgery?
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is an independent risk factor to develop perioperative complications during weight loss surgery, but the mechanisms are unclear. It is possible, that patients with OSA have a higher incidence of desaturation during induction of anesthesia.
  
  
  METHODS
  We enrolled 100 morbidly obese (body mass index: 53+/-10) adult patients undergoing open bariatric surgery in a prospective study. At least 1 h before induction of anesthesia, peripheral oxygen saturation (SpO(2)) was measured by an oximetry finger probe in the sitting and supine positions, and Mallampati score was taken. Oxygen saturation was recorded also during induction of anesthesia, and nadir values were analyzed, and the STOP-BANG questionnaire was applied.
  
  
  RESULTS
  Thirty-six patients presented with clinical suspicion of OSA. Body weight predicted oxygen saturation in the supine and sitting position, prior to induction of anesthesia. Nadir oxygen saturation during induction of anesthesia was considerably higher in patients with clinical suspicion of OSA, a significant finding that persisted as a trend after correction for age, gender and BMI. The Mallampati score was an independent predictor of OSA, even in morbidly obese patients scheduled for weight loss surgery.
  
  
  CONCLUSIONS
  Morbidly obese patients presenting for weight loss surgery have a significant risk to desaturate during induction of anesthesia. A history of OSA does not independently increase the risk of desaturation during induction of anesthesia, if the appropriate precautions are being taken.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
authors.forename: Jaime
authors.initials: J
authors.lastname: Garzon-Serrano
authors.forename: Jean
authors.initials: J
authors.lastname: Kwo
authors.forename: Martina
authors.initials: M
authors.lastname: Grosse-Sundrup
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schmidt
authors.forename: Luca
authors.initials: L
authors.lastname: Bigatello
references.citation: Anesth Analg. 2002 Oct;95(4):1098-102, table of contents
references.pmid: 12351303
references.citation: Eur J Anaesthesiol. 1998 May;15(3):330-4
references.pmid: 9649994
references.citation: Anesth Analg. 2008 Sep;107(3):915-20
references.pmid: 18713905
references.citation: Anesthesiology. 2005 Aug;103(2):429-37
references.pmid: 16052126
references.citation: Anesthesiology. 2008 May;108(5):812-21
references.pmid: 18431116
references.citation: Br J Anaesth. 1998 May;80(5):606-11
references.pmid: 9691863
references.citation: Sleep. 2005 Apr;28(4):499-521
references.pmid: 16171294
references.citation: Eur Respir J. 2010 Sep;36(3):569-76
references.pmid: 20032012
references.citation: N Engl J Med. 2009 Jul 30;361(5):445-54
references.pmid: 19641201
references.citation: Br J Anaesth. 2005 Nov;95(5):706-9
references.pmid: 16143575
references.citation: Anesthesiology. 2009 Jun;110(6):1327-34
references.pmid: 19417601
references.citation: Sleep Med Rev. 2004 Dec;8(6):459-71
references.pmid: 15556378
references.citation: Anesthesiology. 2008 Jun;108(6):1009-15
references.pmid: 18497601
references.citation: Proc Am Thorac Soc. 2008 Feb 15;5(2):185-92
references.pmid: 18250211
references.citation: Int J Obstet Anesth. 2008 Apr;17(2):177-81
references.pmid: 18308555
references.citation: J Clin Invest. 1992 May;89(5):1571-9
references.pmid: 1569196
references.citation: Eur J Anaesthesiol. 2005 Mar;22(3):241-3
references.pmid: 15853002
references.citation: J Clin Invest. 1958 Jul;37(7):1049-60
references.pmid: 13563634
references.citation: J Appl Physiol Respir Environ Exerc Physiol. 1978 Jun;44(6):931-8
references.pmid: 670014
references.citation: Anesthesiology. 2009 Apr;110(4):908-21
references.pmid: 19293689
references.citation: Am J Respir Crit Care Med. 2003 Sep 1;168(5):522-30
references.pmid: 12746251
references.citation: Laryngoscope. 2003 Jun;113(6):973-80
references.pmid: 12782807
references.citation: Anesthesiology. 2009 Feb;110(2):431; author reply 431
references.pmid: 19164965
references.citation: JAMA. 2006 Apr 5;295(13):1549-55
references.pmid: 16595758
references.citation: Curr Opin Anaesthesiol. 2009 Jun;22(3):405-11
references.pmid: 19412094
references.citation: Anesth Analg. 2008 Nov;107(5):1543-63
references.pmid: 18931212
references.citation: Chest. 2007 Jun;131(6):1702-9
references.pmid: 17413053
references.citation: Sleep. 2006 Jul;29(7):903-8
references.pmid: 16895257
references.citation: Anesthesiology. 2009 Apr;110(4):869-77
references.pmid: 19293694
references.citation: Laryngoscope. 1999 Dec;109(12):1901-7
references.pmid: 10591345
references.citation: Obes Surg. 2009 Aug;19(8):1096-101
references.pmid: 18836785
references.citation: Anesthesiology. 2009 Jan;110(1):193; author reply 193-4
references.pmid: 19104189
references.citation: Anesth Analg. 2003 Aug;97(2):595-600
references.pmid: 12873960
references.citation: J Eval Clin Pract. 2011 Feb;17(1):26-31
references.pmid: 20860580