阻塞性睡眠呼吸暂停PPT课件.ppt

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

2、itymovement,turning,vocalization发声,snorting鼻息声)3、Isthereahistoryorobservationofdaytimesomnolence(easilyfallsasleepduringthequiettimesoftheday)Mild(1):obese,snoresmostofthetimetheysleep,notobservedapneaorarousals,notfallsasleepeasilydaytime.Severe(3)：obesem

3、orbidly,snoreallnight,observedapneas&arousalsfrequently,fallsasleepduringmostofthequiettimesduringtheday.Moderate（2）：betweenthesetwoextremesIofA/S：0：superficialsurgery+localanesthesiaorperipheralnerveblock+notsedation1:superficialsurgery+localanesthesiaorp

4、eripheralnerveblock+moderatesedation2:superficialsurgery+generalanesthesia3:majorcavitaryorairwaysurgery+generalanesthesiaPOR:postoperativeopioidrequirementNoPOR,LowDoseOralPOR,ModerateDoseOralPORAndaHighDoseofPOR(0score>>3score)PERIOPERATIVEMANAGEMENTOFOS

5、A：FACILITYOUTPATIENT&INPATIENTRISK=4ANYFACILITYSHOULDHAVE1EMERGENCYDIFFICULTAIRWAYEQUIPMENT2RESPCARERX=NEBULIZES,CPAP,VENTILATORS3PORTABLECHESTX-RAY&ECG4CLINICALLABFORABGS,ELECTROLYTES,HGB/HCTPERIOPERATIVEMANAGEMENTOFOSAPATIENTS:CONSULTANTSAGREEMENTS:PREOP

6、ERATIVE&INTRAOPERATIVEPreoperativepreparationwithcpaporbipapimprovesphysicalstatus.Theairwaymanagementingeneralanesthesia,followASADifficultAirwayGuideline.Moderate/deepsedation--useCO2monitoringGeneralanesthesia+secureairway>deepsedation+noairwayBeextuba

7、tedwhenfullyawakeintheuprightposition&reversalofneuromuscularblockade.Spinal/EpiduralAnesthesiainperipheralsurgery>GA&/orOpioidsCPAPorNIPPVshouldbeadministeredassoonaspossibleaftersurgerytopatientswithOSAwhowerereceivingitpreoperatively.ContinuousbedsideSp

8、O2withoutcontinuousobservationdoesnotprovidethesamelevelofsafety.