Chest
Clinical Investigations: Sleep and BreathingNasal Continuous Positive Airway Pressure in the Perioperative Management of Patients With Obstructive Sleep Apnea Submitted to Surgery
Section snippets
MATERIALS AND METHODS
We present data on 16 patients operated on at the Cliniques Universitaires Saint-Luc between 1988 and 1992. The relevant clinical data are given in Table 1, Table 2, Table 3, Table 4, Table 5. All the patients had a diagnosis of OSAS established before surgery by full-night polysomnography (PSG). As previously described, we recorded EEG, electro-oculogram, chin electromyogram, ECG, respiratory movements assessed by a strain gauge, oronasal flow assessed by three thermocouples, transcutaneous
RESULTS
We shall first report briefly on the cases of three representative patients and then give the general results.
GENERAL RESULTS
As shown in Tables 1 and 2, our patients were representative of the general OSAS population.3 There was a strong male predominance. Thirteen patients were obese (body mass index [BMI] higher than 30 kg.m−2). All had moderate to severe OSAS with AHI ranging from 16 to 89 (median=55). Sleep was fragmented (median MAI=43) and minimal oxygen saturation ranged from 20 to 87% (median minimal SaO2=71%). Treatment with N-CPAP corrected both SaO2 falls due to apneas and hypopneas (median minimal SaO2
DISCUSSION
The main result of this survey is that patients with OSAS treated with N-CPAP before surgery and put back on a regimen of N-CPAP as soon as extubated could undergo a wide variety of surgical procedures without major complications. Moreover, N-CPAP therapy allowed for the safe and unrestricted use of sedative, anesthetic, and analgesic drugs before, during, and after surgery.
The available literature recommends the most extreme care in the perioperative treatment of patients with obstructive
ACKNOWLEDGMENTS
The authors gratefully acknowledge Drs. F. Veyckemans, M. Damiens, and G. Khoury for their cooperation; the nursing and physiotherapy staff of the cardiothoracic and vascular surgery unit for their caring for the patients, M. Y. Genot for providing the financial data of the patients, and Anne Beullens and Isabelle Cap for typing of the manuscript.
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Revision accepted July 25.
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