According to the National Commission on Sleep Disorders Research, approximately 18 million Americans suffer with obstructive sleep apnea (OSA). Unfortunately, the majority of patients with OSA remain undiagnosed . The incidence of sleep apnea increases among obese patients . Since the target population for major liposuction and abdominoplasty includes patients with morbid obesity, concern about OSA becomes more germane.
OSA is a result of a combination of excessive pharyngeal adipose tissue and inadequate pharyngeal soft tissue support . During episodes of sleep apnea, patients may suffer significant and sustained hypox-emia. As a result of the pathophysiology of OSA, patients develop left and right ventricular hypertrophy
. Consequently, patients have a higher risk of ventricular dysarrhythmias and myocardial infarction
Most medications used during anesthesia, including sedatives such as diazepam and midazolam, hypnotics such as propofol, and analgesics such as fentanyl, me-peridine and morphine, increase the risk of airway obstruction and respiratory depression in patients with OSA . Death may occur suddenly and silently in patients with inadequate monitoring . A combination of anatomical abnormalities make airway management, including mask ventilation and endotracheal intubation, especially challenging in obese patients with OSA . Perioperative monitoring, including visual observation, must be especially vigilant to avoid perioperative respiratory arrest in patients with OSA.
For patients with severe OSA, particularly those with additional coexisting medical conditions such as cardiac or pulmonary disease, surgery performed on an outpatient basis is not appropriate. For these high-risk patients, monitoring should continue in the intensive care unit until the patient no longer requires parenteral analgesics. If technically feasible, regional anesthesia may be preferable in patients with severe OSA. Postoperatively, patients with any history of OSA should not be discharged if they appear lethargic or somnolent .
During the preoperative evaluation of the obese patient, a presumptive diagnosis of OSA may be made if the patient has a history of loud snoring, long pauses of breathing during sleep, as reported by the spouse, or daytime somnolence . If OSA is suspected, patients should be referred for a sleep study to evaluate the severity of the condition.
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