title: Snoring is associated with unexpected patient head movement during monitored anesthesia care vitreoretinal surgery.
abstract: OBJECTIVE
  To assess whether snoring is associated with sudden patient movement during local anesthesia with intravenous sedation.
  
  
  METHODS
  In this prospective cohort study, patients undergoing ocular surgery with local anesthesia with intravenous sedation were studied. The occurrence or absence of snoring, and whether patient movement was noted were prospectively recorded. Complications that arose from patient movement were also noted.
  
  
  RESULTS
  A total of 230 surgical procedures were included in the study. All cases were vitreoretinal surgery cases. During 37 procedures, snoring was noted, and among these, 18 patients (48.6%) moved their head suddenly. In contrast, movement occurred during only 2 of 193 procedures (1.0%) without documented snoring (P < 0.001). Thus, sudden patient head movement was approximately 49 times more prevalent in patients who snored. Continuous infusion propofol was also associated with sudden unexpected head movement (P = 0.0028). No complications as a result of the movement were identified in this study.
  
  
  CONCLUSIONS
  Snoring during local anesthesia with intravenous sedation predicts a high likelihood of sudden patient movement during local anesthesia with intravenous sedation. The use of continuous infusion propofol anesthetic may increase the chance of head movement. Eye surgeons should be aware of these associations to help minimize the risk of complications caused by patient movement.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. cmccannel@jsei.ucla.edu
authors.forename: Colin A
authors.initials: CA
authors.lastname: McCannel
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Olson
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Donaldson
authors.forename: Sophie J
authors.initials: SJ
authors.lastname: Bakri
authors.forename: Jose S
authors.initials: JS
authors.lastname: Pulido
authors.forename: Donna
authors.initials: D
authors.lastname: Mueller
mesh_terms: D000772:Anesthesia, Local; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D016292:Procedural Sedation; D005283:Fentanyl / Q000008:administration & dosage; D019416:Head Movements; D006801:Humans; D007431:Intraoperative Complications; D008874:Midazolam / Q000008:administration & dosage; D008991:Monitoring, Physiologic; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D012913:Snoring / Q000150:complications*; D057586:Vitreoretinal Surgery
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol