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Protect apnea patients from perioperative risk

Quality Improvement Monitor, July 11, 2008

For some reason, clinicians suffer from the misapprehension that patients recovering after surgery need to lie flat on their backs—a potentially dangerous position for those who have obstructive sleep apnea (OSA). Della Lin, MD, an anesthesiologist who has served on the American Society of Anesthesiologists (ASA) Patient Safety Committee and executive director of continuing medical education at Queen’s Medical Center in Honolulu, says she wants to disabuse her peers of that notion.

“A lot of patients with obstructive sleep apnea have found that they sleep better on their right-hand side or their left-hand side or sometimes even on their tummy,” says Lin. “I’m always telling the staff, ‘Leave them there. They’re telling us that their body knows the safer position.’ ”

Positioning is only one strategy to protect patients with OSA from lapsing into respiratory arrest, says Lin. Limiting, or even eliminating, the narcotics from a patient’s pain plan following surgery is also critical.

Clinicians may want to consider nonsteroidal anti-inflammatory medications, local anesthetics, and epidurals as alternative pain treatments, Lin says, adding that not all epidurals are created equal. Staff members need to use caution and refrain from using epidurals with heavy doses of narcotics.

And if someone undergoes major surgery and requires patient-controlled anesthesia (PCA), there are advantages to setting the PCA on demand bolus only—using a basal infusion only after serious consideration of the risks and benefits, she adds.

Access the full story in the July issue of the Quality Improvement Report; access is free for subscribers, nonsubscribers can purchase a copy of the story for $10.

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