Obstructive sleep apnoea

A patient with obstructive sleep apnoea is described, who required admission to an intensive care unit on two separate occasions within 2 months. The first admission was after anaesthesia for operation on the upper airway. The second occurred after a relative overdose of an opioid analgesic was administered. The diagnosis, treatment and anaesthetic management of patients with this syndrome are discussed.     

Obstructive sleep apnoea with Arnold-Chiari malformation.

A case of obstructive sleep apnoea associated with the Arnold-Chiari malformation is described, in which the loss of pharyngeal sensation seems to have played an important part in the aetiology of the obstruction of the upper airway.     

Obstructive sleep apnoea and anaesthesia

Obstructive sleep apnoea (OSA) is a common condition affecting approximately 4% of middle-aged individuals. The condition is more common in men with a history of snoring. Patients experience fragmented sleep caused by repetitive obstruction of the upper airway during sleep. There is mounting evidence that OSA is associated with metabolic syndrome. This syndrome comprises hypertension and type 2 diabetes, with associated disturbances of lipid metabolism and central obesity that predisposes to cardiovascular disease. Sleep disruption causes excessive daytime sleepiness and patients may be a danger to themselves or others, especially when driving. Anaesthetists meet the condition frequently, and should have a high index of suspicion when assessing overweight middle-aged patients for surgery. Patients may present for ENT or maxillofacial surgery as part of the management of the condition, but the group at greatest risk are those who are unrecognized and therefore untreated who present for surgery for an unrelated condition. Difficulty with intubation is common, and airway obstruction may occur under anaesthesia if opioid and sedative drugs are used without caution. Many patients also suffer from acid reflux, which may complicate induction of anaesthesia. A plan for difficult airway management is essential, and consideration should be given to carrying out an awake intubation under topical anaesthesia of the upper airway. Knowledge of treatment with nasal continuous positive airway pressure is necessary, and all staff involved should be experienced in the management of such patients during the perioperative period.     

Epidermoid cyst of the mouth floor

The epidermoid cysts are frequent during childhood, however mouth floor location are very unusual, because of their more difficult diagnosis and therapeutic approach. We present a 5 years old male, symptoms free until a week before, when his parents noticed a well defined mass in the mouth floor. A physical examination leaded to the diagnosis of possible epidermoid cyst. The tumor was excised through an introral approach. A review of different diagnostic means and surgical management are undertaken.     

Obstructive sleep apnoea and anaesthesia

Obstructive sleep apnoea (OSA) is the most prevalent sleep disorder, affecting up to 5% of the population. It can have a considerable impact upon perioperative morbidity and mortality. Patients require thorough preoperative assessment including a detailed history, the use of scoring systems to assess severity (such as the STOP-Bang questionnaire and the B-APNEIC score) and physical examination, with particular attention to airway assessment. Elective surgical patients who are deemed to be of high risk for OSA should be referred for polysomnography and implementation of continuous positive airway pressure therapy prior to surgery if indicated. Those patients deemed to be of low risk may be suitable for day surgery. Intraoperative anaesthesia management may include regional anaesthesia, local anaesthetic infiltration, or general anaesthesia depending on both patient and surgical factors. Particular attention should be paid to the potential for difficult airway management and avoidance of sedative agents and opioids where possible. Patients with OSA have an increased risk of cardiovascular and respiratory postoperative complications. Postoperative management should be guided by the severity of OSA, the occurrence of adverse respiratory events in the post anaesthesia care unit and the requirement for opioid analgesia.     

Obstructive sleep apnoea and anaesthesia

Obstructive sleep apnoea is the most prevalent sleep disorder, affecting up to 5% of the population. It can have profound effects on patients perioperatively and can have a considerable impact on morbidity and mortality. Patients require thorough preoperative assessment including the taking of a detailed history, the use of scoring systems to assess severity (such as the STOP-Bang questionnaire) and physical examination with particular attention to the airway. Elective surgery patients who are deemed to be high risk for OSA should be referred for polysomnography with implementation of CPAP prior to surgery if indicated. Those deemed low risk may be suitable for day surgery. Intraoperative anaesthesia management may include regional anaesthesia, local anaesthetic infiltration or general anaesthesia, depending on the symptoms and the nature of surgery. Particular attention should be paid to a potential difficult airway, the use of short acting agents with a rapid wake up and avoidance of sedatives and opioids. OSA patients have an increased risk of cardiovascular and respiratory postoperative complications. Postoperative management should be based on the severity of OSA, the occurrence of adverse respiratory events in the recovery unit and the need for opioid analgesia.     

Obstructive sleep apnoea and anaesthesia

Obstructive sleep apnoea is the most prevalent sleep disorder, affecting up to 5% of the population. It can have profound effects on patients perioperatively and can have a considerable impact on morbidity and mortality. Patients require thorough preoperative assessment including the taking of a detailed history, the use of scoring systems to assess severity (such as the STOP-Bang questionnaire) and physical examination with particular attention to the airway. Elective surgery patients who are deemed to be high risk for OSA should be referred for polysomnography with implementation of CPAP prior to surgery if indicated. Those deemed low risk may be suitable for day surgery. Intraoperative anaesthesia management may include regional anaesthesia, local anaesthetic infiltration or general anaesthesia, depending on the symptoms and the nature of surgery. Particular attention should be paid to a potential difficult airway, the use of short-acting agents with a rapid wake up and avoidance of sedatives and opioids. OSA patients have an increased risk of cardiovascular and respiratory postoperative complications. Postoperative management should be based on the severity of OSA, the occurrence of adverse respiratory events in the recovery unit and the need for opioid analgesia.     

Obstructive sleep apnoea and anaesthesia

Obstructive sleep apnoea (OSA) is a common condition affecting approximately 4% of middle-aged individuals. The condition is more common in men with a history of snoring. Patients experience fragmented sleep caused by repetitive obstruction of the upper airway during sleep. There is mounting evidence that OSA is associated with metabolic syndrome. Metabolic syndrome comprises hypertension and type 2 diabetes, with associated disturbances of lipid metabolism and central obesity that predisposes to cardiovascular disease. Sleep disruption causes excessive daytime sleepiness and patients may be a danger to themselves or others, especially when driving. Anaesthetists meet the condition frequently, and should have a high index of suspicion when assessing overweight middle-aged patients for surgery. Patients may present for ENT or maxillofacial surgery as part of the management of the condition, but the group at greatest risk comprises those who are unrecognized and therefore untreated, who present for surgery for an unrelated condition. Recent screening questionnaires have been developed to aid the anaesthetist in spotting at risk patients, and in predicting the likelihood of postoperative complications.Difficulty with intubation is common, and airway obstruction may occur under anaesthesia if opioid and sedative drugs are used without caution. Many patients also suffer from acid reflux, which may complicate induction of anaesthesia. A plan for difficult airway management is essential, and consideration should be given to carrying out an awake intubation under topical anaesthesia of the upper airway. Knowledge of treatment with nasal continuous positive airway pressure is necessary, and all staff involved should be experienced in the management of such patients during the perioperative period.     

Dermoid cyst of the floor of mouth

A case report of a 30-year-old male with a huge suprahyoid neck swelling and causing respiratory as well as oral function difficulties is reported. The mass was enucleated through oral route, following which normal oral functions as well as respiratory ease were restored. The gross appearance was consistent with dermoid form of congenital cyst of the mouth floor.     

Obstructive sleep apnoea syndrome in children

Obstructive sleep apnoea syndrome in children is a complex disorder characterised by repeated nocturnal episodes of increased upper airway resistive load. It is most commonly associated with adenotonsillar hypertrophy and more children are now presenting for adenotonsillectomy. These children may pose different anaesthetic problems to those having surgery for recurrent infection alone and anaesthetic morbidity and mortality has been reported. In addition, due to the varied symptomatology of the condition, children with unrecognised obstructive sleep apnoea syndrome may present for incidental surgery. This is of importance as patients with undiagnosed obstructive sleep apnoea syndrome may experience additional peri-operative morbidity when undergoing incidental surgery. This article aims to review the aetiology, pathophysiology, clinical presentation and anaesthetic management of children with obstructive sleep apnoea syndrome.