Obstructive Sleep Apnea: Falling Through Caregiver Cracks to Death
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.
KeywordsObstructive 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
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