Clinical Adult Literature Updates from January 2013

Obesity and Postoperative Early Complications in Open Heart Surgery

We found that obesity does not increase short-term mortality for open heart surgery; however, it increases the risk of postoperative pulmonary and gastrointestinal complications and discharge with morbidity.

Outcome of Non-Cardiac, Non-Obstetric Surgery in Patients with Pulmonary Arterial Hypertension: Results From an International Prospective Survey

Data were collected between July 2007 and June 2010 from 114 patients with PAH who underwent major surgery. The authors concluded that major surgery in patients with PAH continues to be a high-risk procedure, in particular when patients need to undergo emergency interventions.

Role of Nocturnal Rostral Fluid Shift in the Pathogenesis of Obstructive and Central Sleep Apnoea

In heart failure patients, with increased rostral fluid shift, fluid may additionally accumulate in the lungs, provoking hyperventilation and hypocapnia, driving PCO2 below the apnoea threshold, leading to CSA. This review article explore mechanisms by which overnight rostral fluid shift, and its prevention, can contribute to the pathogenesis and therapy of sleep apnoea.

Anesthetic Considerations of Parturients with Obesity and Obstructive Sleep Apnea

This review describes the anaesthetic concerns in obese parturients at risk for OSA presenting to the labor and delivery unit.

Proportion of Surgical Patients with Undiagnosed Obstructive Sleep Apnoea

Before operation, of the 267 patients with moderate-to-severe OSA, 92% (n=245) and 60% (n=159) were not diagnosed by the surgeons and the anaesthetists, respectively.This study may provide an impetus for more diligent case finding of OSA before operation.

High Prevalence of Undiagnosed Obstructive Sleep Apnoea in the General Population and Methods for Screening for Representative Controls

The age-standardized prevalence estimate of moderate-severe OSA was 9.1 % (12.4 % in men, 5.7 % in women). Sensitivity of the BQ in this population was 54 %, and specificity, 70 %. A combination of questions regarding snoring frequency and hypertension provided maximal post-test probability of OSA and greatest post-screen sample size.

Continuous Positive Airway Pressure Improves Sleepiness But Not Calculated Vascular Risk in Patients with Minimally Symptomatic Obstructive Sleep Apnoea: The MOSAIC Randomised Controlled Trial

In patients with minimally symptomatic OSA, CPAP can reduce subjective and objective daytime sleepiness, and improve self-assessed health status, but does not appear to improve calculated vascular risk.

Sleep Apnea: Is Routine Preoperative Screening Necessary?

Sleep apnea screening prior to bariatric surgery identifies an additional 25 % of patients as having OSA. In this study, unscreened morbidly obese patients did not have an increased incidence of cardiopulmonary complications after surgery compared to screened patients.

Perinatal Outcomes Associated With Obstructive Sleep Apnea in Obese Pregnant Women

Obstructive sleep apnea among obese pregnant women is associated with more frequent preeclampsia, neonatal intensive care unit admissions, and cesarean delivery.