Advertisement

Obstructive Sleep Apnea: Falling Through Caregiver Cracks to Death

  • Christopher Nguyen
  • Jonathan L. Benumof
Chapter

Abstract

This chapter discusses the case of a 53-year-old woman with obstructive sleep apnea who underwent an exploratory laparotomy for abdominal pain. Her postoperative course was marked by multiple transitions of care between providers who did not appreciate the severity of her sleep apnea and failed to communicate crucial information to subsequent providers. As a result, the patient had a prolonged apneic event and suffered cardiopulmonary arrest resulting in hypoxic encephalopathy. The chapter proceeds with a review of the problems posed by obstructive sleep apnea to the anesthesiologist, including issues with intubation, extubation, and postoperative care. There is a discussion of the interpretation of the patient’s sleep study results and the underlying upper airway anatomy and pathophysiology. The chapter then discusses the American Society of Anesthesiologist’s practice guideline for obstructive sleep apnea, including a review of the causes and diagnosis of obstructive sleep apnea, methods for assessing severity and assigning a perioperative risk score, and finally a discussion of the perioperative management of obstructive sleep apnea. The chapter closes with a re-examination of the initial case and highlights opportunities for improvement in patient safety.

Keywords

Obstructive sleep apnea, complications Obstructive sleep apnea, therapy Obstructive sleep apnea, diagnosis Perioperative care Preoperative care Postoperative care Obesity Morbid obesity Monitoring, physiologic Continuous positive airway pressure Practice guidelines Patient safety Quality improvement Risk assessment Anesthesia Anesthesia recovery Postanesthesia care unit Narcotics Ambulatory surgical procedures Difficult airway, assessment Airway management, methods Airway extubation, methods Upper airway anatomy Sleep study, interpretation Transitions of care 

References

  1. 1.
    Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A, American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–70.CrossRefGoogle Scholar
  2. 2.
    American Society of Anesthesiologists. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Anesthesiology. 2014;120(2):268–86.CrossRefGoogle Scholar
  3. 3.
    American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Christopher Nguyen
    • 1
  • Jonathan L. Benumof
    • 2
  1. 1.Department of AnesthesiologyUniversity of California, San DiegoOrangeUSA
  2. 2.Department of AnesthesiologyUniversity of California, UCSD Medical Center, UCSD School of MedicineSan DiegoUSA

Personalised recommendations