Postoperative Management 

 

Risk factors for post-op Respiratory depression

  • Severity of the sleep apnea

  • Systemic opioids

  • Use of sedatives

  • Site & invasiveness of surgical procedure

  • The potential for apnea during rapid eye movement (REM) sleep on the third or fourth postoperative day (i.e., “REM rebound”), as sleep patterns are reestablished.

 

Post-op Analgesia/Sedation

  • Consider regional if possible 

  • If epidural post-op, weigh cons/benefits epidural opioids vs local alone 

  • If PCA, avoid continuous background infusion 

  • Consider multimodal analgesia (NSAIDs, tylenol, etc) 

  • Caution using any sedatives 

 

Oxygenation 

  • Use supplemental oxygen 

  • Use CPAP/BiPAP if they were on it.  Use their own device as it improves compliance 

 

Other Points 

  • Positioning: if possible, place in non-supine positions 

  • Hospitalized patients who are at ↑ risk of respiratory compromise from OSA should have continuous pulse oximetry monitoring after discharge from the recovery room. Continuous monitoring may be provided in a critical care or stepdown unit, by telemetry on a hospital ward

  • Frequent or severe airway obstruction or hypoxemia occurs during postoperative monitoring, initiation of nasal CPAP or NIPPV should be considered.  

 

 

Adapted from:

  • American Society of Anesthesia Guidelines 2014:  Anesthesiology. 2014 Feb;120(2):268-86.

  • The Canadian Anesthesia Society Guidelines 2010:  Can J Anaesth. 2010 Sep;57(9):849-64