阻塞性睡眠呼吸暫停

1、CAUSES OF OSA:OBESITY BMI ≥ 35MICROGNATHIA & RETROGNATHIA NECK ≥ 17” (MEN), 16” (WOMEN)NASAL OBSTRUCTION BIG TONSILS/LARGE TONGUE,,1、Is there is a history or observation of apnea or snoring with hypopnea (sleep

2、disordered breathing SDB)2、Is there a history or observation of arousal from sleep(extremity movement,turning, vocalization發(fā)聲, snorting鼻息聲 )3、Is there a history or observation of daytime somnolence (easily falls asleep

3、 during the quiet times of the day),,Mild(1): obese, snores most of the time they sleep, not observed apnea or arousals, not falls asleep easily daytime.Severe(3)：obese morbidly, snore all night, observed apneas & a

4、rousals frequently, falls asleep during most of the quiet times during the day.Moderate（2）：between these two extremes,,I of A/S：0：superficial surgery + local anesthesia or peripheral nerve block + not sedation1: super

5、ficial surgery + local anesthesia or peripheral nerve block + moderate sedation2: superficial surgery + general anesthesia 3: major cavitary or airway surgery + general anesthesiaPOR: postoperative opioid requirement

6、No POR, Low Dose Oral POR ,Moderate Dose Oral PORAnd a High Dose of POR (0 score >>3score),PERIOPERATIVE MANAGEMENT OF OSA：FACILITY OUTPATIENT & INPATIENT,RISK =4 ANY FACILITY SHOULD HAVE 1 EMERGENCY DIFFICU

7、LT AIRWAY EQUIPMENT 2 RESP CARE RX= NEBULIZES,CPAP,VENTILATORS3 PORTABLE CHEST X-RAY & ECG 4 CLINICAL LAB FOR ABGS,ELECTROLYTES, HGB/HCT,PERIOPERATIVE MANAGEMENT OF OSA PATIENTS:CONSULTANTS AGREEMENTS: PREOPERATIV

8、E & INTRAOPERATIVE,Preoperative preparation with cpap or bipap improves physical status.The airway management in general anesthesia, follow ASA Difficult Airway Guideline.Moderate/deep sedation - - ?use CO2 monito

9、ringGeneral anesthesia + secure airway > deep sedation +no airwayBe extubated when fully awake in the upright position & reversal of neuromuscular blockade.Spinal/Epidural Anesthesia in peripheral surgery> G

10、A& /or Opioids,CPAP or NIPPV should be administered as soon as possible after surgery to patients with OSA who were receiving it preoperatively.Continuous bedside SpO2 without continuous observation does not provide