title: A systematic review of the effects of sedatives and anesthetics in patients with obstructive sleep apnea.
abstract: The objective of this review is to determine the effects of perioperative sedatives and anesthetics in surgical patients with obstructive sleep apnea (OSA) on respiratory events, medication requirements, hemodynamics, pain, emergence, and hospital stay. We searched The Cochrane CENTRAL Register of Controlled Trials, Medline, Embase, and Cochrane Database of Systematic Reviews from 1950 to June 2010 for relevant articles. All prospective and retrospective studies were eligible for inclusion if the effects of perioperative administration of sedation and anesthetics on medication requirements, pain, emergence, hemodynamics, respiratory events, and length of hospital stay in OSA patients were reported. The search strategy yielded 18 studies of 1467 patients. Of these, 456 patients were documented as having OSA. Few adverse respiratory effects were reported. Eight out of 700 (1.14%) patients undergoing middle ear surgery with midazolam and fentanyl had impaired upper airway patency and were retrospectively diagnosed as having OSA by polysomnography. Also, intraoperative snoring causing uvular edema in the postoperative period was described in an OSA patient undergoing upper limb surgery when propofol was administered with midazolam and fentanyl for sedation. A decrease in oxygen saturation in the postoperative period was described with propofol and isoflurane in 21 OSA patients undergoing uvulo-palato-pharyngoplasty and tonsillectomy surgery (P<0.05). Perioperative alpha 2 agonists were shown to decrease the use of anesthetics (P<0.05), analgesics (P=0.008) and anti-hypertensives (P<0.001) in OSA patients. Contradictory reports regarding emergence occurred with intraoperative dexmedetomidine. Intraoperative opioids decreased the analgesic consumption (P=0.03) and pain scores (P<0.05) in the postoperative period. There was limited data on the length of hospital stay. There were few adverse effects reported when patients with known OSA underwent elective surgery with the currently available sedatives and anesthetics. Adverse events were reported with midazolam. However, the quality and number of patients in the studies were limited. There is a need for further trials with large numbers and uniform reporting of outcomes.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Saravanan
authors.initials: S
authors.lastname: Ankichetty
authors.forename: Jean
authors.initials: J
authors.lastname: Wong
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
references.citation: Am Rev Respir Dis. 1992 Feb;145(2 Pt 1):435-9
references.pmid: 1736753
references.citation: Am Rev Respir Dis. 1985 Dec;132(6):1242-5
references.pmid: 3935019
references.citation: Anesthesiology. 1992 Dec;77(6):1125-33
references.pmid: 1361310
references.citation: Can J Anaesth. 1999 Sep;46(9):894-6
references.pmid: 10490161
references.citation: Paediatr Anaesth. 2000;10(6):645-51
references.pmid: 11119198
references.citation: Can J Anaesth. 2009 Nov;56(11):819-28
references.pmid: 19774431
references.citation: Br J Anaesth. 1993 Sep;71(3):388-92
references.pmid: 8398521
references.citation: Eur J Pharmacol. 1993 Jul 6;238(1):75-80
references.pmid: 8405085
references.citation: Can J Anaesth. 2010 May;57(5):423-38
references.pmid: 20143278
references.citation: Anesth Analg. 2011 Jan;112(1):113-21
references.pmid: 21081775
references.citation: Eur J Anaesthesiol. 2009 Feb;26(2):176-7
references.pmid: 19142095
references.citation: Anesth Analg. 1998 Jan;86(1):202-7
references.pmid: 9428879
references.citation: J Laryngol Otol. 2010 Jan;124(1):67-72
references.pmid: 19852868
references.citation: Anesth Prog. 2006 Spring;53(1):13-6
references.pmid: 16722279
references.citation: Can J Anaesth. 2005 Feb;52(2):176-80
references.pmid: 15684259
references.citation: Arch Otolaryngol Head Neck Surg. 2001 Oct;127(10):1216-23
references.pmid: 11587602
references.citation: Open Respir Med J. 2010 Jun 25;4:58-62
references.pmid: 20802806
references.citation: Anesthesiology. 1992 Dec;77(6):1116-24
references.pmid: 1466464
references.citation: Am Rev Respir Dis. 1988 Dec;138(6):1542-7
references.pmid: 3202504
references.citation: Br J Anaesth. 1985 Mar;57(3):306-10
references.pmid: 3978013
references.citation: Br J Anaesth. 1990 Dec;65(6):744-8
references.pmid: 2265043
references.citation: Br J Anaesth. 1996 Feb;76(2):266-70
references.pmid: 8777108
references.citation: J Oral Maxillofac Surg. 2005 Jun;63(6):752-5
references.pmid: 15944969
references.citation: Mayo Clin Proc. 2001 Sep;76(9):897-905
references.pmid: 11560300
references.citation: J Clin Anesth. 2007 Aug;19(5):370-3
references.pmid: 17869990
references.citation: Br J Anaesth. 1992 Jan;68(1):27-31
references.pmid: 1739562
references.citation: J Clin Anesth. 1998 Dec;10(8):660-5
references.pmid: 9873968
references.citation: Can J Anaesth. 2004 Mar;51(3):279
references.pmid: 15010419
references.citation: Br J Anaesth. 1995 Apr;74(4):492-3
references.pmid: 7734278
references.citation: J Clin Anesth. 2008 Jun;20(4):297-9
references.pmid: 18617130
references.citation: Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):608-13
references.pmid: 11254512
references.citation: Crit Care. 2000;4(5):302-8
references.pmid: 11056756
references.citation: Sleep. 2011 Mar 01;34(3):283-91A
references.pmid: 21358845
references.citation: J Clin Anesth. 2003 Aug;15(5):375-7
references.pmid: 14507566
references.citation: Mil Med. 2009 Jan;174(1):100-2
references.pmid: 19216305
references.citation: Anaesth Intensive Care. 1994 Apr;22(2):165-9
references.pmid: 7880227
references.citation: N Engl J Med. 1993 Apr 29;328(17):1230-5
references.pmid: 8464434
references.citation: Anesthesiology. 2002 Oct;97(4):786-93
references.pmid: 12357141
references.citation: Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):450-4
references.pmid: 7842205
references.citation: J Appl Physiol Respir Environ Exerc Physiol. 1978 Jun;44(6):931-8
references.pmid: 670014
references.citation: Am J Respir Crit Care Med. 2003 Sep 1;168(5):522-30
references.pmid: 12746251
references.citation: Trends Pharmacol Sci. 2005 Oct;26(10):503-10
references.pmid: 16126282
references.citation: Respir Physiol Neurobiol. 2002 Jul;131(1-2):15-27
references.pmid: 12106992
references.citation: Int J Obes Relat Metab Disord. 2004 Sep;28(9):1157-62
references.pmid: 15311219
references.citation: Anesth Analg. 2008 Nov;107(5):1543-63
references.pmid: 18931212
references.citation: Am J Respir Crit Care Med. 2002 May 1;165(9):1217-39
references.pmid: 11991871
references.citation: Anesthesiology. 2000 Nov;93(5):1345-9
references.pmid: 11046225
references.citation: Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):740-8
references.pmid: 10934114
references.citation: Crit Care Med. 1986 Feb;14(2):167-8
references.pmid: 3943324
references.citation: Am Rev Respir Dis. 1991 Jun;143(6):1300-3
references.pmid: 2048817
references.citation: Anesthesiology. 1994 Apr;80(4):727-38
references.pmid: 8024126
references.citation: Acta Anaesthesiol Belg. 2003;54(3):227-32
references.pmid: 14598620
references.citation: Acta Anaesthesiol Scand. 1994 Oct;38(7):694-8
references.pmid: 7839779
references.citation: Am J Respir Crit Care Med. 1998 Jan;157(1):144-8
references.pmid: 9445292
references.citation: Anesthesiology. 2006 May;104(5):1081-93; quiz 1117-8
references.pmid: 16645462
references.citation: Crit Care Med. 2002 May;30(5):1007-14
references.pmid: 12006795
references.citation: J Vet Med Sci. 1999 Sep;61(9):1033-8
references.pmid: 10535509
references.citation: J Clin Anesth. 2001 Dec;13(8):565-70
references.pmid: 11755325
references.citation: Anesthesiol Clin. 2010 Jun;28(2):199-215
references.pmid: 20488390
references.citation: Eur Respir J. 2010 Sep;36(3):569-76
references.pmid: 20032012
references.citation: Anesth Analg. 2008 Jul;107(1):138-43
references.pmid: 18635479
references.citation: Anesth Analg. 2005 Nov;101(5):1374-1380
references.pmid: 16243997
references.citation: Anesth Analg. 2000 Sep;91(3):714-9
references.pmid: 10960406
references.citation: Sleep. 2011 Mar 01;34(3):247-8
references.pmid: 21358839
references.citation: J Clin Anesth. 2006 Sep;18(6):452-4
references.pmid: 16980164
references.citation: Anesthesiology. 2005 Sep;103(3):470-7
references.pmid: 16129969
references.citation: Nat Rev Neurosci. 2004 Sep;5(9):709-20
references.pmid: 15322529