The adult patient with sleep apnea syndrome for ambulatory anesthesia

Patients with OSA are at a high risk of perioperative complications and pose several challenges to the anesthetist, including difficult tracheal intubation and increased perioperative complications (e.g., respiratory obstruction and respiratory depression). Sinceundiagnosed OSA is common, a focused history and physical examination can help identify patients with OSA. It is unclear if a routine preoperative sleep study would influence perioperative outcome. Nevertheless, when a sleep study is not available, it is prudent to treat patients as though they have severe OSA. Patients who use a CPAP device at home should be advised to bring the device to the hospital.There is uncertainty regarding scheduling and management of OSA patients for outpatient surgery. With limited understanding of their postoperative (particularly post-discharge) course, any recommendations remain speculative. Prudent perioperative management should be guided by an awareness of the potential complications based on the severity of OSA, invasiveness of the procedure, and requirement of postoperative analgesia. Development of protocols for perioperative care as well as patient and surgeon education should reduce complications and improve outcomes.