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CPAP facilitates sedation of patients with obstructive sleep apnoea
Author(s) -
Reid J.,
Picton P.
Publication year - 2005
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2005.04352.x
Subject(s) - medicine , sedation , midazolam , propofol , continuous positive airway pressure , population , anesthesia , hypoxia (environmental) , obstructive sleep apnea , intensive care medicine , chemistry , environmental health , organic chemistry , oxygen
The incidence of obesity, with associated obstructive sleep apnoea, has been steadily increasing in the UK over recent years [1, 2]. Regional techniques are often preferred in order to avoid general anaesthesia and its associated morbidity and mortality in this patient population [3]. During long procedures under regional anaesthesia it is our experience that patients often become uncomfortable and intolerant without sedation. The morbidly obese population, however, is often denied sedation for fear of airway obstruction, leading to hypoxia. We propose that patients who are treated with CPAP for obstructive sleep apnoea use their device during procedures requiring sedation. At the University of Michigan (in one of America’s ‘fattest’ states) [4], patients who have obstructive sleep apnoea are routinely asked to bring their CPAP machines to hospital when they attend for elective procedures, to prevent nocturnal hypoxia in the postoperative period. We have found that sedation can be used safely in this population by asking the patient to apply their own CPAP device at the start of the case. Our technique has been to sedate cautiously using midazolam (1–2 mg) or propofol (10– 30 lg.kg.min). Supplemental oxygen is applied either directly via the CPAP circuit (when the design allows) or via nasal cannulae under the mask. This latter approach is well tolerated and does not seem to interfere with the performance of the CPAP system. Similar patients in the UK should be encouraged to bring their CPAP machines with them for both intraand postoperative use.