Patients with obstructive sleep apnoea are at high risk of developing complications when having surgery .These patients are particularly vulnerable during anaesthesia and sedation. They should be alert to patients who are at risk of having obstructive sleep apnoea and be aware of the potential preoperative and postoperative complications in such patients.
Management options include alternative methods of pain relief, use of nasal continuous airway pressure before and after surgery, and surveillance in an intensive care unit, especially after nasal surgery in which packs are used.
Alterations in craniofacial morphology contributing to obstructive sleep apnoea—such as macroglossia, retrognathia, a narrow hypopharynx because of fat deposition in the lateral walls of the pharynx, or an anteriorly displaced larynx—also have an impact on anaesthetic management.
Any patient diagnosed as having obstructive sleep apnoea or in whom it is suspected on the basis of clinical signs (obesity, limited mouth opening, or a large tongue) should be treated as having a difficult airway until proved otherwise. Orotracheal intubation, especially in severely obese patients with obstructive sleep apnoea, may be extremely difficult, and postoperative airway obstruction due to swelling or bleeding should be anticipated. Of course, no staging system can prevent unexpected difficulties in tracheal intubation.
In the case of a medical history suggestive of obstructive sleep apnoea, particularly in obese patients with a short bulky neck and a large tongue, full night polysomnography should ideally be done before surgery takes place.
More details in the video clips: Please See the Video Clips For General Anesthesia for Laser Surgery for Snoring and Sleep Apnea
