阻塞性睡眠呼吸暂停课件

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1、CAUSESOFOSA:OBESITYBMI≥35MICROGNATHIA&RETROGNATHIANECK≥17”(MEN),16”(WOMEN)NASALOBSTRUCTIONBIGTONSILS/LARGETONGUE1、Isthereisahistoryorobservationofapneaorsnoringwithhypopnea(sleepdisorderedbreathingSDB)2、Isthereahistoryorobservationofarousalfromsleep(extremitymovement,turning,vocali

2、zation发声,snorting鼻息声)3、Isthereahistoryorobservationofdaytimesomnolence(easilyfallsasleepduringthequiettimesoftheday)Mild(1):obese,snoresmostofthetimetheysleep,notobservedapneaorarousals,notfallsasleepeasilydaytime.Severe(3)：obesemorbidly,snoreallnight,observedapneas&arousalsfrequen

3、tly,fallsasleepduringmostofthequiettimesduringtheday.Moderate（2）：betweenthesetwoextremesIofA/S：0：superficialsurgery+localanesthesiaorperipheralnerveblock+notsedation1:superficialsurgery+localanesthesiaorperipheralnerveblock+moderatesedation2:superficialsurgery+generalanesthesia3:ma

4、jorcavitaryorairwaysurgery+generalanesthesiaPOR:postoperativeopioidrequirementNoPOR,LowDoseOralPOR,ModerateDoseOralPORAndaHighDoseofPOR(0score>>3score)PERIOPERATIVEMANAGEMENTOFOSA：FACILITYOUTPATIENT&INPATIENTRISK=4ANYFACILITYSHOULDHAVE1EMERGENCYDIFFICULTAIRWAYEQUIPMENT2RESPCARERX=N

5、EBULIZES,CPAP,VENTILATORS3PORTABLECHESTX-RAY&ECG4CLINICALLABFORABGS,ELECTROLYTES,HGB/HCTPERIOPERATIVEMANAGEMENTOFOSAPATIENTS:CONSULTANTSAGREEMENTS:PREOPERATIVE&INTRAOPERATIVEPreoperativepreparationwithcpaporbipapimprovesphysicalstatus.Theairwaymanagementingeneralanesthesia,followAS

6、ADifficultAirwayGuideline.Moderate/deepsedation--useCO2monitoringGeneralanesthesia+secureairway>deepsedation+noairwayBeextubatedwhenfullyawakeintheuprightposition&reversalofneuromuscularblockade.Spinal/EpiduralAnesthesiainperipheralsurgery>GA&/orOpioidsCPAPorNIPPVshouldbeadministe

7、redassoonaspossibleaftersurgerytopatientswithOSAwhowerereceivingitpreoperatively.ContinuousbedsideSpO2withoutcontinuousobservationdoesnotprovidethesamelevelofsafety.