Do Special Measures—Such as Postoperative CPAP, a Prolonged PACU Stay, and PACU EtCO2 Monitoring—Improve the Outcome in a Patient with Obstructive Sleep Apnea?

Abstract

As the anesthesiologist in charge, I was kept informed of all complications in the post-anesthesia care unit (PACU). Most, when investigated, were isolated incidents and not systemic PACU deficiencies. However, over a few weeks last January, a man was found with an oxygen saturation of 89 % requiring opioid reversal and then a woman had a full respiratory arrest resulting in reintubation. Three similar cases in February set all of us on edge. With some detective work and analysis, one commonality was discovered: All carried a preoperative diagnosis of obstructive sleep apnea (OSA). Was this coincidence or connection? The department chairman wisely asked me to look into the issue and to suggest solutions. My mission was to decide whether patients with OSA should be treated differently in the PACU and to implement new policies to improve patient safety (and not unduly utilize resources).