Literature Updates from March 2013

The Effect of A Quality Improvement Intervention on Perceived Sleep Quality and Cognition in a Medical ICU

In this study, the authors sought to determine if a multifaceted quality improvement initiative could improve sleep and delirium at a tertiary academic medical center. 300 adult patients, who spent one at least one night in the medical ICU, were evaluated for perceived sleep quality, ICU noise levels and delirium free days. The authors discovered that their multi-staged quality improvement project was easy to implement and resulted in reduced noise ratings, decreased incidence of delirium and coma, and increased daily delirium and coma free status. Improvements in perceived sleep did not reach statistical significance. Despite the lack of improvement in perceived sleep, the author’s multi-disciplinary multifaceted approach seemed to have merit with regards to improving delirium and coma.

Dissociation of Electromyogram and Mechanical Response in Sleep Apnoea During Propofol Anaesthesia

Pharyngeal collapsibility during sleep is believed to increase due to a decline in dilator muscle activity. However, genioglossus electromyogram (EMG) often increases during apnoeas and hypopnoeas, often without mechanical effect. During propofol anaesthesia, pharyngeal occlusion persists despite large increases in genioglossus EMG, in the presence of a preserved mechanical response to electrical stimulation.

How Can We Improve Mask Ventilation in Patients with Obstructive Sleep Apnea During Anesthesia Induction?

Anesthesiologists can decrease respiratory complications during anesthesia induction by conducting careful pre-induction preparations, including body and head positioning and sufficient preoxygenation, and by using the two-hand mask ventilation technique with effective airway maneuvers and appropriate ventilator settings while continuously assessing ventilation status with capnography.

Proportion of Surgical Patients with Undiagnosed Obstructive Sleep Apnoea

Obstructive sleep apnea (OSA) affects 9–24% of the general population, and 90% remain undiagnosed. Those patients with undiagnosed moderate-to-severe OSA may be associated with an increased risk of perioperative complications. The objective was to evaluate the proportion of surgical patients with undiagnosed moderate-to-severe OSA. Anesthesiologists and surgeons failed to identify a significant number of patients with pre-existing OSA and symptomatic undiagnosed OSA, before operation. This study may provide an impetus for more diligent case finding of OSA before operation.

Strategies in Postoperative Analgesia in the Obese Obstructive Sleep Apnea Patient

This is a narrative review of the impact of sedative and analgesic therapy on the intraoperative and postoperative course of an obese OSA patient. An understanding of postoperative complications related to OSA and drug interactions in the context of opioid and nonopioid selection may benefit pain practitioner and patients equally. Management of acute postoperative pain in OSA patient remains complex. A comprehensive strategy is needed to reduce the complications and adverse events related to administration of analgesics and anesthetics.

Perioperative Risk Stratification for a Patient with Severe Obstructive Sleep Apnoea Undergoing Laparoscopic Banding Surgery

This case report describes the perioperative management of a 46-year-old Caucasian male with a body mass index of 51 kg/m(2) admitted for laparoscopic band insertion. Management based on local institutional guidelines involved a preoperative polysomnography where the patient was confirmed to have severe OSA. His postoperative care was then managed in the high dependency care unit. He was discharged home on day 2 with no further sequelae. The authors provide evidence that adoption of this model of care can simplify clinical decision making and resource allocation with favorable patient outcomes.

Does Auto-Titrating Positive Airway Pressure Therapy Improve Postoperative Outcome in Patients at Risk for Obstructive Sleep Apnea Syndrome? A Randomized Controlled Clinical Trial

The role for empiric postoperative APAP requires further study, but our findings did not show benefit for APAP applied postoperatively to PAP naïve patients at high-risk for sleep apnea.

Continuous Positive Airway Pressure Treatment of Sleepy Patients with Milder Obstructive Sleep Apnea: Results of the CPAP Apnea Trial North American Program (CATNAP) Randomized Clinical Trial

Continuous positive airway pressure treatment improves the functional outcome of sleepy patients with mild and moderate obstructive sleep apnea.