Risk of pulmonary complications in surgical patients

Mircea, N; Constantinescu, Corneliu; Jianu, E; Buşu, G

doi:10.1016/0300-9572(82)90006-5

Cited by 15 publications

(6 citation statements)

References 1 publication

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“…Surgical patients are at higher risk of having complications for a variety of reasons, including ASA (American Society of Anesthesiologists) class, 72 [84][85][86] type of anesthesia, 73,78,87,88 and other comorbidities-especially chronic obstructive pulmonary disease, coronary artery disease, and renal failure. 79,80,89 The risk of postoperative complications also depends on the type of surgery.…”

Section: Evidence On Sleep Apnea As a Risk Factor For Perioperative Cmentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Vasu

Grewal

Doghramji

2012

Journal of Clinical Sleep Medicine

217

147

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Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. OSAS has been shown to be associated with various healthrelated consequences, including increased rate of motor vehicle accidents, hypertension, diabetes mellitus, congestive heart failure, stroke, and all-cause mortality. [1][2][3][4][5][6][7][8][9] Recently, numerous studies have demonstrated that surgical patients with sleep apnea are at increased risk of having perioperative complications, including hypoxemia, pneumonia, diffi cult intubation, myocardial infarction, pulmonary embolism, atelectasis, cardiac arrhythmias, and unanticipated admission to the ICU. The majority of patients with OSA are undiagnosed upon admission and are at risk during the perioperative period, presumably due to their underlying sleep apnea. Therefore, it is very important to identify these patients preoperatively so that one can initiate appropriate perioperative measures. EpidemiologyOSAS is an extremely common sleep related breathing disorder, and its prevalence has been increasing throughout the world because of obesity and increasing age of the general population. Its prevalence is between 2% and 25% in the general population, depending upon how sleep apnea is defi ned. In an epidemiological study, Young et al. noted that the prevalence of sleep apnea, defi ned as apnea-hypopnea index (AHI) ≥ 5/h was 9% for women and 24% for men. 10 However, the prevalence of OSAS (defi ned as AHI ≥ 5/h and daytime sleepiness) was 2% in women and 4% in men. 10 The National Sleep Foundation (NSF) Sleep in America 2005Poll found that 1 in 4 Americans are at high risk of having sleep apnea based on the Berlin Questionnaire. 11 The prevalence of sleep apnea is much higher in surgical patients and depends on the type of surgery. In the bariatric surgery population, the prevalence of sleep apnea has been found to be > 70%. 12,13 It is the standard of care for these patients to get a formal sleep evaluation prior to undergoing the bariatric surgery. Howev...

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Section: Evidence On Sleep Apnea As a Risk Factor For Perioperative Cmentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Vasu

Grewal

Doghramji

2012

Journal of Clinical Sleep Medicine

217

147

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“…Smokers have been shown to have increased risk of intraoperative pulmonary complications (1), and a wide range of postoperative complications as well (2). The most common postoperative complications are pulmonary (3–7), cardiovascular (8, 9) and wound infection or failure of healing (10). The relationship between tobacco smoking and intensive care admittance is poorly described in the literature, although there could be plenty of reasons to assume that smokers have a greater risk of being admitted to the intensive care unit (4, 11).…”

mentioning

confidence: 99%

Postoperative intensive care admittance: The role of tobacco smoking

Møller

Maaløe

Pedersen

2001

Acta Anaesthesiol Scand

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“…Among morbidly obese patients undergoing cesarean section, prolonged surgery and intraoperative blood loss are associated with the increase in post operative morbidity [27]. As expected, obese parturients are more likely to develop postoperative pulmonary complications, such as hypoxemia, atelectasis, and pneumonia [76,77]. Even in healthy obese patients, postoperative hypoxemia occurs universally after cesarean section under general anesthesia.…”

Section: Postoperative Considerationsmentioning

confidence: 97%