Literature Updates from September 2012

Noninvasive Positive-Pressure Ventilation (NPPV) for Acute Respiratory Failure [Internet]

This study is a systematic review of the literature on the role of Noninvasive positive-pressure ventilation (NPPV) in the setting of acute respiratory failure. Reviewing more than 50 studies, the author concluded that for patients with acute respiratory failure due to severe exacerbations of COPD or congestive heart failure, NPPV improves outcomes compared to supportive care alone.

http://www.ncbi.nlm.nih.gov/pubmed/22876372

Pulmonary Complications After Elective Liver Transplantation-Incidence, Risk Factors, and Outcome

The postoperative clinical course of 212 liver transplant recipients between January 2008 and April 2010 was analyzed. Pneumonia was the most common complication among patients undergoing liver transplants and was a major cause of morbidity. A restrictive pattern on preoperative pulmonary testing and a higher international normalized ratio measured prior to surgery were associated with higher risk of postoperative pneumonia.

http://www.ncbi.nlm.nih.gov/pubmed/22885879

Total Joint Arthroplasty in Patients with Obstructive Sleep Apnea: Strategies for Reduction of Perioperative Complications

The authors of this study report on their institution’s efforts to employ postoperative precautions for OSA patients in an effort to minimize the impact of postoperative complications in this group. They conclude that their “postoperative monitoring protocols are successful in reducing postoperative complications most commonly associated with OSA.

http://www.ncbi.nlm.nih.gov/pubmed/22505000

Respiratory Perioperative Management of Patients With Obstructive Sleep Apnea

Perioperative management of a patient with OSA should be modified and may include regional anesthesia and alternative analgesic techniques such as nonsteroidal anti-inflammatory drugs that may reduce the need for systemic opioids. Additionally, supplemental O2 and continuous pulse oximetry monitoring should be utilized to maintain baseline O2 saturation. Postoperatively patients should remain in a semi-upright position and positive pressure therapy should be used in patients with high-risk OSA.

http://www.ncbi.nlm.nih.gov/pubmed/22588375

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.

http://www.ncbi.nlm.nih.gov/pubmed/22833138

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.

http://www.ncbi.nlm.nih.gov/pubmed/22846679

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.

http://www.ncbi.nlm.nih.gov/pubmed/21626286

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.

http://www.ncbi.nlm.nih.gov/pubmed/21240655

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.

http://www.ncbi.nlm.nih.gov/pubmed/22281801