Abstract
Purpose
Sleep apnoea syndrome (SAS) is a relatively common, potentially fatal, disorder. Patients with SAS exhibit repetitive, often prolonged episodes of apnoea during sleep, with serious nocturnal and diurnal physiologic derangements. Several anecdotal reports and clinical studies have documented anaesthetic-related occurrence of fatal and near-fatal respiratory complications in these patients. The purpose of this article is to outline the potential problems encountered in anaesthetic management of adult SAS patients, and to suggest a practical approach for anaesthesia both for incidental and specific procedures.
Principal findings
SASs have many implications for the anaesthetist. First, SAS patients are exquisitely sensitive to all central depressant drugs, with upper airway obstruction or respiratory arrest occurring even with minimal doses. Thus sedative and opioid premedication should be omitted as should the intra and postoperative use of opioids be limited or avoided. All anaesthetic drugs should be administered by titration to desired effect, preferably using short-acting drugs. When feasible, continuous regional anaesthesia using a catheter is the technique of choice. Where possible nonopioid analgesics or local anaesthetics should be used for postoperative analgesia. Perioperative monitoring for apnoea, desaturation, and dysrhythmias is essential. Secondly, SAS patients have a potentially difficult airway. Awake intubation is the safest approach to airway control. Extubation should only be tried in the fully conscious patient with intact upper airway function and under controlled situations. Thirdly, the cardiorespiratory complications of SAS and the presence of associated diseases can adversely influence anaesthetic management.
Conclusion
Perioperative risks attending SAS patients emphasize the importance of their detection, perioperative evaluation and planning.
Résumé
Objectif
Le syndrome d’apnée du sommeil (SAS) est une affection relativement fréquente et potentiellement fatale. Ce syndrome est caractérisé par des périodes répétées et souvent prolongées d’apnée pendant le sommeil avec des dérèglements physiologiques nocturnes et diurnes graves. Plusieurs observations anecdotiques et cliniques ont rapporté, la survenue de complications fatales ou quasi fatales en rapport avec l’anesthésie de ces patients. Cet article vise à mettre en lumière les problèmes potentiels à envisager pour la gestion anesthésique des porteurs adultes du SAS et à suggérer une approche pratique pour l’anesthésie autant en vue d’une chirurgie en général que pour certaine interventions spécifiques.
Constatations principales
Le SAS a plusieurs répercussions sur l’anesthésie. D’abord, les patients souffrants de SAS sont extrêmement sensibles à tous les agents qui dépriment le SNC avec la conséquence que l’obstruction des voies respiratoires supérieures et l’arrêt respiratoire peuvent survenir même avec des doses infinitésimales. La prémédication aux sédatifs ou aux morphiniques doit être omise. Il faut aussi éviter ou au moins diminuer l’administration des morphiniques peret postopératoires. Tous les anesthésiques doivent être administrés en titrant la posologie pour obtenir l’effet désiré préférablement avec des agents à courte durée d’action. Lorsque c’est possible, l’anesthésie régionale continue avec un cathéter est la technique de choix. De la même façon, des analgésiques non morphiniques devraient être utilisés pour l’analgésie postopératoire. Le monitorage de la respiration, de la saturation et du rythme cardiaque est essentiel. Deuxièmement, chez ces patients, l’accès aux voies aériennes peut être difficile. L’intubation à l’état vigile représente la meilleure méthode de contrôle des voies aériennes. L’extubation ne devrait être tentée que chez un patient complètement conscient dont le fonctionnement des voies aériennes est intact. Troisièmement, les complications cardiorespiratoires du SAS et les maladies associées peuvent influencer défavorablement la gestion de l’anesthésie.
Conclusion
Les dangers périopératoires qui menacent le patient souffrant de SAS soulignent l’importance de leur détection, de l’évaluation périopératoire et de la planification.
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An erratum to this article is available at http://dx.doi.org/10.1007/BF03011858.
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Boushra, N.N. Anaesthetic management of patients with sleep apnoea syndrome. Can J Anaesth 43, 599–616 (1996). https://doi.org/10.1007/BF03011774
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DOI: https://doi.org/10.1007/BF03011774