Society for Ambulatory Anesthesia Consensus Statement on Preoperative Selection of Adult Patients with Obstructive Sleep Apnea Scheduled for Ambulatory Surgery

Abstract

The suitability of ambulatory surgery for a patient with obstructive sleep apnea (OSA) remains controversial because of concerns of increased perioperative complications including postdischarge death. Therefore, a Society for Ambulatory Anesthesia task force on practice guidelines developed a consensus statement for the selection of patients with OSA scheduled for ambulatory surgery. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Although the studies evaluating perioperative outcome in OSA patients undergoing ambulatory surgery are sparse and of limited quality, they do provide useful information that can guide clinical practice. Patients with a known diagnosis of OSA and optimized comorbid medical conditions can be considered for ambulatory surgery, if they are able to use a continuous positive airway pressure device in the postoperative period. Patients with a presumed diagnosis of OSA, based on screening tools such as the STOP-Bang questionnaire, and with optimized comorbid conditions, can be considered for ambulatory surgery, if postoperative pain can be managed predominantly with nonopioid analgesic techniques. On the other hand, OSA patients with nonoptimized comorbid medical conditions may not be good candidates for ambulatory surgery. What other guidelines are available on this topic? The American Society of Anesthesiologists (ASA) practice guidelines for management of surgical patients with OSA published in 2006. Why was this guideline developed? The ASA guidelines are outdated because several recent studies provide new information such as validated screening tools for clinical diagnosis of OSA and safety of ambulatory laparoscopic bariatric surgery in OSA patients. Therefore, an update on the selection of patients with OSA undergoing ambulatory surgery is warranted. How does this guideline differ from existing guidelines? Unlike the ASA guidelines, this consensus statement recommends the use of the STOP-Bang criteria for preoperative OSA screening and considers patients' comorbid conditions in the patient selection process. Also, current literature does not support the ASA recommendations that upper abdominal procedures are not appropriate for ambulatory surgery. Why does this guideline differ from existing guidelines? This consensus statement differs from existing ASA guidelines because of the availability of new evidence.

The importance of obstructive sleep apnoea management in peri-operative medicine

“…At present, the optimal clinical pathway for surgical patients with newly diagnosed OSA has not been determined [21,22,[28][29][30][31]. Should we diagnose and treat OSA before surgery?…”

Perioperative fellowship curricula in anesthesiology: a systematic review

“…In Canada for example, topics such as perioperative management of diabetes mellitus, [34][35][36][37][38][39] obstructive sleep apnea, 22,[40][41][42] pacemakers and automated implantable cardioverter defibrillators (AICDs), [43][44][45] anticoagulation, 46,47 and fluid management 48,49 are covered under the national curriculum during residency to ensure all anesthesiologists are qualified to manage these common conditions and situations. 50 Nevertheless, other more specialized areas demand fellowship training, such as focused cardiac ultrasound to manage hemodynamic instability, administrative management skills, complex sleep disordered breathing, advanced preoperative patient counselling, and roles similar to hospitalists.…”

“…22,40,41 It has significant implications for anesthesiologists, and extensive perioperative guidelines have been published with respect to its management. 22,[55][56][57] The newly formed Society of Anesthesia and Sleep Medicine indicates the wide interest in this area.…”

Perioperative management of patients with obstructive sleep apnea: a survey of Canadian anesthesiologists

“…Interestingly, it is a more conservative viewpoint than the approach suggested in the 2012 Society for Ambulatory Anesthesia (SAMBA) consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. 24 There are limitations to the results of our survey. First, although we aimed to describe current practices, a survey study is designed to evaluate opinions of respondents.…”