- Case study:
- Obese female patient for laparoscopic gynaecological surgery.
- Not optimised (non-compliant) on CPAP for known severe OSA
- Conversion from laparoscopy to laparotomy due to surgical difficulty
- Hypercapnoeic in PARU with imbalance between opioid requirements and respiratory drive.
- Admitted to ICU overnight for observation and NIV
- Recognised that day 3 (after ICU discharge) remains a high risk time for these patients, with resumption of normal sleep architecture and ongoing opioid requirements, leading to risk of opioid-induced hypoventilation and respiratory arrest.
- Proactive perioperative efforts are leading to a large workload increase for the respiratory teams, with identification of so many patients at risk of severe OSA or with known OSA but not optimised.
- Long wait-lists for OSA assessment and management in the public health system (up to 12 months).
- New guideline being developed to identify the patients at highest risk perioperatively, to guide who should be referred to the respiratory teams, to maximise our use of this finite resource.