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Perioperative care of patients with obstructive sleep apnea – a survey of Canadian anesthesiologists

[La prise en charge périopératoire des patients atteints d’apnée du sommeil d’origine obstructive – une enquête auprès des anesthésiologistes canadiens]

Kim Turner, MD MSc^*,, Elizabeth VanDenKerkhof, DRPH^*,,, Miu Lam, PhD and William Mackillop, MB CHB^,

^* From the Departments of Anesthesiology, Community Health and
Epidemiology,
Nursing, and
Radiation Oncology Research Unit, Queen’s University, Kingston General Hospital, Kingston, Ontario, Canada.

Address correspondence to: Dr. Kim Turner, Department of Anesthesiology, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7. Phone: 613-549-6666, ext. 3135; Fax: 613-548-1375; E-mail: turnerk{at}kgh.kari.net

Purpose: At present, there are no guidelines and insufficient evidence to guide the decision-making of anesthesiologists in the perioperative care of patients with obstructive sleep apnea (OSA). The purpose of this study was to examine the current perioperative care provided, and to obtain opinions from anesthesiologists regarding evidence/consensus based guidelines to assist them in providing care to patients with OSA.

Methods: Canadian anesthesiologists were sent a postal questionnaire examining their opinions and perioperative care of patients with OSA. Respondents were asked to indicate the postoperative monitoring they would most likely select for two clinical scenarios, representing administration of a general and regional anesthetic, which was altered to reflect: treatment of OSA; use of postoperative opioids; presence of morbid obesity; and increased severity of OSA.

Results: The survey had a response rate of 70% (746/1,063). Sixty-seven percent of respondents provided perioperative care to one to five patients with OSA per month, and 72% reported not having departmental policies for care of OSA patients. Ninety-two percent reported asking patients about OSA preoperatively. There was 75% respondent agreement in two of the five alterations of the general anesthesia case scenario and in none of the alterations of the regional anesthesia case scenario. Eighty-two percent reported that guidelines would assist them in caring for patients with OSA.

Conclusion: This study demonstrates a variation amongst anesthesiologists in their postoperative monitoring of patients with OSA. The majority surveyed do not have departmental policies, and believed that guidelines would assist them in providing care to patients with OSA.