Perioperative care of patients with obstructive sleep apnea — a survey of Canadian anesthesiologists

PURPOSE: At present, there are no guidelines and insufficient evidence to guide the decision-making of anesthesiologists in the perioperative care of patients with obstructive sleep apnea (OSA). The purpose of this study was to examine the current perioperative care provided, and to obtain opinions from anesthesiologists regarding evidence/consensus based guidelines to assist them in providing care to patients with OSA. METHODS: Canadian anesthesiologists were sent a postal questionnaire examining their opinions and perioperative care of patients with OSA. Respondents were asked to indicate the postoperative monitoring they would most likely select for two clinical scenarios, representing administration of a general and regional anesthetic, which was altered to reflect: treatment of OSA; use of postoperative opioids; presence of morbid obesity; and increased severity of OSA. RESULTS: The survey had a response rate of 70% (746/1,063). Sixty-seven percent of respondents provided perioperative care to one to five patients with OSA per month, and 72% reported not having departmental policies for care of OSA patients. Ninety-two percent reported asking patients about OSA preoperatively. There was >or= 75% respondent agreement in two of the five alterations of the general anesthesia case scenario and in none of the alterations of the regional anesthesia case scenario. Eighty-two percent reported that guidelines would assist them in caring for patients with OSA. CONCLUSION: This study demonstrates a variation amongst anesthesiologists in their postoperative monitoring of patients with OSA. The majority surveyed do not have departmental policies, and believed that guidelines would assist them in providing care to patients with OSA.