Clinical Adult Literature Updates from September 2012

Perioperative Management of the Severely Obese Patient: A Selective Pathophysiological Review

The literature clearly highlights the complexity of severe obesity as a multisystem disease, and anesthesiologists caring for these patients perioperatively must have a sound understanding of the changes in order to offer the highest quality care to these patients.

Interface of Sleep and Anesthesia

The increasing prevalence of sleep disorders in surgical patients, the interfaces of sleep and anesthesia are now a pressing clinical concern. This article discusses sleep and anesthesia from the perspective of phenotype, mechanism and function, with some concluding thoughts on the relevance to neuroanesthesiology

Mashour GA, Pal D

Effects of Muscle Relaxants on Mask Ventilation in Anesthetized Persons with Normal Upper Airway Anatomy

Rocuronium did not deteriorate facemask ventilation, and it was improved after succinylcholine administration in association with airway dilation during pharyngeal fasciculation. This effect continued to a lesser degree after resolution of the fasciculation.

Is Mandatory Screening for Obstructive Sleep Apnea with Polysomnography in All Severely Obese Patients Indicated?

The prevalence of OSA in the bariatric surgical patients was 56% in female and 77 % in males. BMI, age, and male gender were independent predictors of OSA. Males and females with age greater than 49 years are at greatest risk for OSA. Preoperative sleep studies should be mandatory in this group of severely obese patients.

Anesthesiologist’s Knowledge and Attitudes About Obstructive Sleep Apnea: A Survey Study

The study shows that anesthesiologists lack adequate knowledge about OSA. The total correct score ratio was 62%; when they managed an OSA patient, the positive attitude score is mostly below 50%. They have low confidence about OSA patients. It is necessary to develop special training programs on OSA regularly for anesthesiologists after graduation.

Long-Term Auto Servo-Ventilation or Constant Positive Pressure in Heart Failure and Co-Existing Central with Obstructive Sleep Apnea

Patients with CHF may have complex sleep disordered breathing (SDB) with combination of obstructive sleep apnea and central sleep apnea/Cheyne-Stokes breathing. In this RCT, the use of Auto-Servo Ventilation (ASV) in CHF patients with complex SDB results in significant improvement in central apnea hypopnea index and brain natriuretic peptide levels compared to CPAP.