阻塞性睡眠呼吸暂停-医学课件演示.pptVIP

CAUSES OF OSA: OBESITY BMI ≥ 35 MICROGNATHIA RETROGNATHIA NECK ≥ 17” (MEN), 16” (WOMEN) NASAL OBSTRUCTION BIG TONSILS/LARGE TONGUE 1、Is there is a history or observation of apnea or snoring with hypopnea (sleep disordered breathing SDB) 2、Is there a history or observation of arousal from sleep(extremity movement,turning, vocalization发声, snorting鼻息声 ) 3、Is there a history or observation of daytime somnolence (easily falls asleep during the quiet times of the day) Mild(1): obese, snores most of the time they sleep, not observed apnea or arousals, not falls asleep easily daytime. Severe(3)：obese morbidly, snore all night, observed apneas arousals frequently, falls asleep during most of the quiet times during the day. Moderate（2）：between these two extremes I of A/S： 0：superficial surgery + local anesthesia or peripheral nerve block + not sedation 1: superficial surgery + local anesthesia or peripheral nerve block + moderate sedation 2: superficial surgery + general anesthesia 3: major cavitary or airway surgery + general anesthesia POR: postoperative opioid requirement No POR, Low Dose Oral POR ,Moderate Dose Oral POR And a High Dose of POR (0 score 3score) PERIOPERATIVE MANAGEMENT OF OSA：FACILITY OUTPATIENT INPATIENT RISK =4 ANY FACILITY SHOULD HAVE 1 EMERGENCY DIFFICULT AIRWAY EQUIPMENT 2 RESP CARE RX= NEBULIZES,CPAP,VENTILATORS 3 PORTABLE CHEST X-RAY ECG 4 CLINICAL LAB FOR ABGS,ELECTROLYTES, HGB/HCT PERIOPERATIVE MANAGEMENT OF OSA PATIENTS:CONSULTANTS AGREEMENTS: PREOPERATIVE INTRAOPERATIVE Preoperative preparation with cpap or bipap improves physical status. The airway management in general anesthesia, follow ASA Difficult Airway Guideline. Moderate/deep sedation - - ?use CO2 monitoring General anesthesia + secure airway deep sedation +no airway Be extubated when fully awake in the upright position reversal of neuromuscular blockade. Spinal/Epidural Anesthesia in peripheral surgery GA /or Opioids CPAP or NIPPV should be administered as soon as poss