OSA assessment and optimisation

Gabrielle Morris

Background

  • 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.

Discussion

  • 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.