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

Dawson, David M.; Singh, Mandeep; Chung, Frances

doi:10.1111/anae.13362

Cited by 11 publications

(9 citation statements)

References 82 publications

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“…Both actigraphy and polysomnography could be easily used in an intensive care setting , with minimal disruption or discomfort to the patient, and the use of polysomnography in addition to actigraphy would be especially important given that patients in intensive care are likely to be sedated. Furthermore, the addition of the recording of respiratory parameters and pulse oximetry in polysomnography could facilitate assessment of sleep apnoea in postoperative settings, allowing enhanced understanding of the association of obstructive sleep apnoea with adverse peri‐operative outcomes .…”

Section: Discussionmentioning

confidence: 99%

Sleep disturbance in patients taking opioid medication for chronic back pain

et al. 2016

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SummaryPoor sleep is an increasingly recognised problem with chronic pain and further increases the effect on daily function. To identify the relationship between chronic pain, opioid analgesia and sleep quality, this study investigated activity and sleep patterns in patients taking opioid and non‐opioid analgesia for chronic back pain. Thirty‐one participants (10 healthy controls, 21 patients with chronic pain: 6 on non‐opioid medication; 15 on opioid medication) were assessed using actigraphy, polysomnography and questionnaires. Patients with chronic pain subjectively reported significant sleep and wake disturbances as shown by decreased overall sleep quality (Pittsburgh Sleep Quality Index, p < 0.001), increased symptoms of insomnia (Insomnia Severity Index, p < 0.001) and increased fatigue (Fatigue Severity Scale, p = 0.002). They also spent increased time in bed (p = 0.016), took longer to get to sleep (p = 0.005) and had high interindividual variability in other measures of activity but no overall irregular rest‐activity pattern. Patients on high doses of opioids (> 100 mg morphine‐equivalent/day) demonstrated distinctly abnormal brain activity during sleep suggesting that polysomnography is necessary to detect sleep disturbance in this population in the absence of irregular rest‐activity behaviour. Night‐time sleep disturbance is common in individuals suffering from chronic pain and may be further exacerbated by opioid treatment. Considerations must be made regarding the appropriate use of combined actigraphy and miniaturised polysomnography for future population‐based studies.

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Section: Discussionmentioning

confidence: 99%

Sleep disturbance in patients taking opioid medication for chronic back pain

et al. 2016

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“…121 150 Reduced doses of opioids should therefore be administered to some patients with known or suspected OSA, because opioid dose is correlated with postoperative increases in OSA and therefore the potential for PPCs. 150…”

Section: Analgesiamentioning

confidence: 99%

Postoperative pulmonary complications

Miskovic

Lumb

2017

British Journal of Anaesthesia

774

596

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Postoperative pulmonary complications (PPCs) are common, costly, and increase patient mortality. Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug. The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery. Risk factors for PPC development are numerous, and clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care. Many validated risk prediction models are described. These have been useful for improving our understanding of PPC development, but there remains inadequate consensus for them to be useful clinically. Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight. Further evidence for the most beneficial level of PEEP is required, and on-going randomized trials will hopefully provide more information. When PEEP is used, it may be useful to precede this with a recruitment manoeuvre if atelectasis is suspected. For high-risk patients, surgical time should be minimized. After surgery, nasogastric tubes should be avoided and analgesia optimized. A postoperative mobilization, chest physiotherapy, and oral hygiene bundle reduces PPCs.

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“…Nurse-led pre-operative assessment is now commonplace in elective surgical pathways in many hospitals [ 1 , 2 ]. The role of the pre-operative assessment physician is multi-faceted with several key components: optimisation of patient health to try and reduce peri-operative complications [ 3 , 4 ]; management of co-existing medical conditions in accordance with latest guidance [ 5 , 6 ]; provision of patient education as part of peri-operative care bundles [ 7 , 8 ]; ensuring that appropriate, patient-centred investigations are undertaken [ 9 , 10 ]; and provision of information relevant to consent for surgery [ 11 ]. It is recognised that well trained nursing staff can play an ever-increasing role in pre-operative assessment providing they are well trained [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

A prospective observational study of the impact of an electronic questionnaire (ePAQ-PO) on the duration of nurse-led pre-operative assessment and patient satisfaction

et al. 2018

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ObjectiveStandard pre-operative assessment at our institution involves a comprehensive history and examination by a nurse practitioner. An electronic pre-operative assessment questionnaire, ePAQ-PO® (ePAQ, Sheffield, UK) has previously been developed and validated. This study aimed to determine the impact of ePAQ-PO on nurse consultation times and patient satisfaction in low-risk patients.MethodsThe duration of pre-operative assessment consultation was recorded for American Society of Anesthesiology physical classification 1 and 2 patients undergoing pre-operative assessment by an electronic questionnaire (ePAQ-PO group) and standard face-to-face assessment by a nurse practitioner (standard group). Patients were also asked to complete an eight-item satisfaction questionnaire. Eighty-six patients were included (43 in each group).ResultsAfter adjusting for the duration of physical examination, median (IQR [min-max]) consultation time was longer in the standard compared to the ePAQ-PO group (25 (18–33 [10–49]) min vs. 12 (8–17 [4–45]) min, respectively; p <0.001). Response rate for the satisfaction questionnaire was 93%. There was no significant difference in patient satisfaction scores (38/39 in standard group vs. 39/41 in ePAQ-PO group were fully satisfied with their pre-operative assessment; p = 0.494).ConclusionPre-operative assessment using ePAQ-PO is associated with a significant reduction of over 50% in the duration of the assessment without impacting on patient satisfaction.

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

Abstract: ☛ CPD available at http://www.learnataagbi.org

Cited by 11 publications

References 82 publications

Sleep disturbance in patients taking opioid medication for chronic back pain

Sleep disturbance in patients taking opioid medication for chronic back pain

Postoperative pulmonary complications

A prospective observational study of the impact of an electronic questionnaire (ePAQ-PO) on the duration of nurse-led pre-operative assessment and patient satisfaction

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