Ambulatory surgical patients and sleep apnea

OSA is widely prevalent in the surgical population and is associated with increased perioperative morbidity and mortality secondary to respiratory and cardiovascular complications.While it is difficult to establish a direct causal relationship betweenOSA and perioperative complications due to the high burden of comorbidities present in this population, recognition of this disease process and implementation of clinical strategies will increase perioperative safety (Fig. 3). All surgical patients should undergo a screening forOSA. While there is insufficient evidence to delay or cancel procedures to obtain a confirmed diagnosis and initiate PAP therapy, it is important to optimize comorbid conditions associated with OSA. Regional anesthesia should be used when possible and if general anesthesia is deemed necessary, a fast-track general anesthetic technique should be utilized A high degree of vigilance is required in the immediate postoperative period for early identification and management of cardiorespiratory complications. Patient and family education regarding postoperative opioid reduction is imperative in the recovery process. Finally, anesthesia societies must make a push for consistent practices and guidelines regarding perioperative management of these patients and emphasize the need for properly designed and adequately powered studies that report the effects of perioperative interventions and improvement in the complication rates for patients with OSA.