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Prof. Dr. Roop Kaw

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Departments of Hospital Medicine & Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
Interests: perioperative medicine; obstructive sleep apnea (OSA); obesity hypoventilation; pulmonary hypertension; postoperative respiratory failure

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Dear Colleagues,

The area of preoperative evaluation and perioperative management in patients with respiratory disease and for those at risk for respiratory complications is rapidly evolving. Lots of new literature has emerged over the last decade or two with the addition of some disease-specific guidelines and position papers. These include recommendations on the anesthetic management of OSA, obesity hypoventilation syndrome and pulmonary hypertension. These conditions may oftentimes come to the surface for the first time during a preoperative evaluation and when unrecognized can impact the postoperative course. Similarly, neuromuscular disease has major implications perioperatively and this area is also evolving in regards to airway management. Finally, whether or not to monitor postoperative patients on non-ICU floors for respiratory complications is an area of intense debate and controversy and is in need of high-quality research. In this Special Issue, we invite papers from authors and investigators who have spent considerable time studying these issues as well as those who have provided clinical experience and consensus.

Prof. Dr. Roop Kaw
Guest Editor

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Keywords

perioperative medicine
obstructive sleep apnea (OSA)
obesity hypoventilation
pulmonary hypertension
postoperative respiratory failure

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Review

16 pages, 1193 KiB

Open AccessReview

Obstructive Sleep Apnea and Risk of Postoperative Complications after Non-Cardiac Surgery

by Rabail Arif Chaudhry, Lori Zarmer, Kelly West and Frances Chung

J. Clin. Med. 2024, 13(9), 2538; https://doi.org/10.3390/jcm13092538 - 26 Apr 2024

Viewed by 192

Abstract

Obstructive sleep apnea (OSA), a common sleep disorder, poses significant challenges in perioperative management due to its complexity and multifactorial nature. With a global prevalence of approximately 22.6%, OSA often remains undiagnosed, and increases the risk of cardiac and respiratory postoperative complications. Preoperative screening has become essential in many institutions to identify patients at increased risk, and experts recommend proceeding with surgery in the absence of severe symptoms, albeit with heightened postoperative monitoring. Anesthetic and sedative agents exacerbate upper airway collapsibility and depress central respiratory activity, complicating intraoperative management, especially with neuromuscular blockade use. Additionally, OSA patients are particularly prone to opioid-induced respiratory depression, given their increased sensitivity to opioids and heightened pain perception. Thus, regional anesthesia and multimodal analgesia are strongly advocated to reduce perioperative complication risks. Postoperative care for OSA patients necessitates vigilant monitoring and tailored management strategies, such as supplemental oxygen and Positive Airway Pressure therapy, to minimize cardiorespiratory complications. Health care institutions are increasingly focusing on enhanced monitoring and resource allocation for patient safety. However, the rising prevalence of OSA, heterogeneity in disease severity, and lack of evidence for the efficacy of costly perioperative measures pose challenges. The development of effective screening and monitoring algorithms, alongside reliable risk predictors, is crucial for identifying OSA patients needing extended postoperative care. This review emphasizes a multidimensional approach in managing OSA patients throughout the perioperative period, aiming to optimize patient outcomes and minimize adverse outcomes. Full article

(This article belongs to the Special Issue Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery)

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Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery

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