scholarly journals Intrathecal Morphine and Pulmonary Complications after Arthroplasty in Patients with Obstructive Sleep Apnea

2020 ◽  
Vol 132 (4) ◽  
pp. 702-712 ◽  
Author(s):  
Johnny W. Bai ◽  
Mandeep Singh ◽  
Anthony Short ◽  
Didem Bozak ◽  
Frances Chung ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Respiratory Depression ◽  
Low Dose ◽  
Pulmonary Complication ◽  
Intrathecal Morphine ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complication ◽  
Postoperative Pulmonary Complications ◽  
Obstructive Sleep

Abstract Background Intrathecal morphine is commonly and effectively used for analgesia after joint arthroplasty, but has been associated with delayed respiratory depression. Patients with obstructive sleep apnea may be at higher risk of postoperative pulmonary complications. However, data is limited regarding the safety of intrathecal morphine in this population undergoing arthroplasty. Methods This retrospective cohort study aimed to determine the safety of intrathecal morphine in 1,326 patients with documented or suspected obstructive sleep apnea undergoing hip or knee arthroplasty. Chart review was performed to determine clinical characteristics, perioperative events, and postoperative outcomes. All patients received neuraxial anesthesia with low-dose (100 μg) intrathecal morphine (exposure) or without opioids (control). The primary outcome was any postoperative pulmonary complication including: (1) respiratory depression requiring naloxone; (2) pneumonia; (3) acute respiratory event requiring consultation with the critical care response team; (4) respiratory failure requiring intubation/mechanical ventilation; (5) unplanned admission to the intensive care unit for respiratory support; and (6) death from a respiratory cause. The authors hypothesized that intrathecal morphine would be associated with increased postoperative complications. Results In 1,326 patients, 1,042 (78.6%) received intrathecal morphine. The mean age of patients was 65 ± 9 yr and body mass index was 34.7 ± 7.0 kg/m2. Of 1,326 patients, 622 (46.9%) had suspected obstructive sleep apnea (Snoring, Tired, Observed, Pressure, Body Mass Index, Age, Neck size, Gender [STOP-Bang] score greater than 3), while 704 of 1,326 (53.1%) had documented polysomnographic diagnosis. Postoperatively, 20 of 1,322 (1.5%) patients experienced pulmonary complications, including 14 of 1,039 (1.3%) in the exposed and 6 of 283 (2.1%) in the control group (P = 0.345). Overall, there were 6 of 1 322 (0.5%) cases of respiratory depression, 18 of 1,322 (1.4%) respiratory events requiring critical care team consultation, and 4 of 1,322 (0.3%) unplanned intensive care unit admissions; these rates were similar between both groups. After adjustment for confounding, intrathecal morphine was not significantly associated with postoperative pulmonary complication (adjusted odds ratio, 0.60 [95% CI, 0.24 to 1.67]; P = 0.308). Conclusions Low-dose intrathecal morphine, in conjunction with multimodal analgesia, was not reliably associated with postoperative pulmonary complications in patients with obstructive sleep apnea undergoing joint arthroplasty. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

An assessment of opioids on respiratory depression in children with and without obstructive sleep apnea

2021 ◽  
Author(s):  
Adam C. Adler ◽  
Arvind Chandrakantan ◽  
Brian H. Nathanson ◽  
Britta S. von Ungern‐Sternberg
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Respiratory Depression ◽  
Obstructive Sleep

Pain Management for the Obese Sleep Apnea Patient

ICU Director ◽  
2012 ◽  
Vol 3 (2) ◽  
pp. 80-84 ◽  
Author(s):  
Mark A. Schumacher
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pain Management ◽  
Side Effects ◽  
Respiratory Depression ◽  
Adult Population ◽  
Opioid Analgesic ◽  
Sleep Apnea Syndromes ◽  
Obese Patients ◽  
Obstructive Sleep

Currently, one third of the US adult population is considered obese. As such, obese patients are a rapidly growing population of patients being admitted to ICU. The problems in managing pain for these patients, primarily perioperative and hospital-associated respiratory depression, are becoming increasingly apparent. New approaches for pain management are intended to minimize the life-threatening side effects of traditional pain control drugs (opioids) and to increase the therapeutic options with nonopioid agents. This article ( a) reviews the pathophysiology of obstructive sleep apnea and other related sleep apnea syndromes, ( b) describes risk factors for perioperative and hospital-associated respiratory depression, ( c) reviews other significant side effects of opioid analgesic agents, and finally ( d) summarizes the emerging consensus for the use of multimodal analgesia for managing pain in obese patients with obstructive sleep apnea.

scholarly journals Pulmonary complications in trauma patients with obstructive sleep apnea undergoing pelvic or lower limb operation

2020 ◽  
Vol 5 (1) ◽  
pp. e000529
Author(s):  
Michele Fiorentino ◽  
Franchesca Hwang ◽  
Sri Ram Pentakota ◽  
David H Livingston ◽  
Anne C Mosenthal
Keyword(s):  
Obstructive Sleep Apnea ◽  
Logistic Regression ◽  
Respiratory Failure ◽  
Sleep Apnea ◽  
Lower Limb ◽  
Independent Predictor ◽  
Ventilatory Support ◽  
Pulmonary Complications ◽  
Trauma Patients ◽  
Obstructive Sleep

BackgroundObstructive sleep apnea (OSA) is increasingly prevalent in the range of 2% to 24% in the US population. OSA is a well-described predictor of pulmonary complications after elective operation. Yet, data are lacking on its effect after operations for trauma. We hypothesized that OSA is an independent predictor of pulmonary complications in patients undergoing operations for traumatic pelvic/lower limb injuries (PLLI).MethodsNationwide Inpatient Sample (2009–2013) was queried for International Classification of Diseases, Ninth Revision, Clinical Modification codes for PLLI requiring operation. Elective admissions and those with concurrent traumatic brain injury with moderate to prolonged loss of consciousness were excluded. Outcome measures were pulmonary complications including ventilatory support, ventilator-associated pneumonia, pulmonary embolism (PE), acute respiratory distress syndrome (ARDS), and respiratory failure. Multivariable logistic regression analysis was used, adjusting for OSA, age, sex, race/ethnicity, and specific comorbidities (obesity, chronic lung disease, and pulmonary circulatory disease). P<0.01 was considered statistically significant.ResultsAmong the 337 333 patients undergoing PLLI operation 3.0% had diagnosed OSA. Patients with OSA had more comorbidities and were more frequently discharged to facilities. Median length of stay was longer in the OSA group (5 vs 4 days, p<0.001). Pulmonary complications were more frequent in those with OSA. Multivariable logistic regression showed that OSA was an independent predictor of ventilatory support (adjusted odds ratio (aOR), 1.37; 95% CI,1.24 to 1.51), PE (aOR 1.40; 95% CI, 1.15 to 1.70), ARDS (aOR 1.36; 95% CI,1.23 to 1.52), and respiratory failure (aOR 1.90; 95% CI, 1.74 to 2.06).ConclusionOSA is an independent and underappreciated predictor of pulmonary complications in those undergoing emergency surgery for PLLI. More aggressive screening and identification of OSA in trauma patients undergoing operation are necessary to provide closer perioperative monitoring and interventions to reduce pulmonary complications and improve outcomes.Level of evidencePrognostic Level IV.

Videoradiography of Patients with Habitual Snoring and/or Sleep Apnea

1996 ◽  
Vol 37 (1P1) ◽  
pp. 307-314 ◽  
Author(s):  
B. Hillarp ◽  
G. Nylander ◽  
I. Rosén ◽  
O. Wickström
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Low Dose ◽  
Sleep Apnea Syndrome ◽  
Continuous Recording ◽  
Habitual Snoring ◽  
Obstructive Sleep ◽  
Apnea Syndrome ◽  
Sleep Recording

Purpose: The videoradiographic examination described was designed for habitual snorers and sleep apnea syndrome (SAS) patients and was performed during wakefulness and sleep. During wakefulness the purpose was to reveal any dysfunction in deglutition and speech as well as morphologic abnormalities. The purpose during sleep, which usually was induced by low-dose midazolam intravenously, was to reveal the site and form of obstruction in obstructive sleep apnea patients and the site of snoring in habitual snorers. Material: The preoperative results of 104 patients are presented. In 57 patients who had apneas, the occurrence and type of apnea could be determined. Results and Conclusion: A continuous recording over some minutes gave a rough estimate of the degree of SAS and mean duration of apnea. Although much information on SAS can be obtained by this method, it cannot replace polygraphic sleep recording in the investigation of habitual snorers and SAS patients. However, these 2 methods are complementary and can be performed simultaneously as polygraphic videoradiography.

The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay

2021 ◽  
pp. 026921552110432
Author(s):  
Xinyi Xu ◽  
Denise Shuk Ting Cheung ◽  
Robert Smith ◽  
Agnes Yuen Kwan Lai ◽  
Chia-Chin Lin
Keyword(s):  
Lung Cancer ◽  
Hospital Stay ◽  
Pulmonary Complication ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Postoperative Pulmonary Complication ◽  
Postoperative Pulmonary Complications

Objective: To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. Review methods: Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. Results: Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = −1.68 days, 95% CI = −2.23, −1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = −0.23 days, 95% CI = −1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = −0.17, 95% CI = −0.29, −0.05). Conclusion: Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.

Recurrent Hypoxia in Rats during Development Increases Subsequent Respiratory Sensitivity to Fentanyl

2006 ◽  
Vol 105 (4) ◽  
pp. 715-718 ◽  
Author(s):  
Immanuela Ravé Moss ◽  
Karen A. Brown ◽  
André Laferrière
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tidal Volume ◽  
Respiratory Depression ◽  
Whole Body ◽  
Respiratory Drive ◽  
Oxygen Balance ◽  
Obstructive Sleep ◽  
History Of ◽  
Respiratory Sensitivity

Background In children with a history of significant obstructive sleep apnea who undergo adenotonsillectomy, postsurgical administration of opiates has been alleged to be associated with an increased risk for respiratory complications, including respiratory depression. The authors hypothesize that this association is due to an effect of recurrent hypoxemia that accompanies more severe obstructive sleep apnea on altered responsiveness to subsequent exogenous opiates. Methods The current study was designed to test the effect of recurrent hypoxia in the developing rat on respiratory responses to subsequent administration of the mu-opioid agonist fentanyl. Rats were exposed to 12% oxygen balance nitrogen for 7 h daily for 17 days, from postnatal day 17 to 33, a period equivalent to human childhood. After 17 additional days in room air, rats were given a fentanyl dose and tested for their respiratory response to fentanyl using a whole body plethysmograph. Rats undergoing similar protocols without recurrent hypoxia served as controls. Results As compared with controls, rats preexposed to recurrent hypoxia displayed a more profound depression with fentanyl in minute ventilation, respiratory frequency, tidal volume, and tidal volume divided by inspiratory time that represents respiratory drive. These results indicated an increased respiratory sensitivity to fentanyl after recurrent hypoxia. Conclusions Previous recurrent hypoxia increases respiratory sensitivity to subsequent opiate agonists. If these findings are applicable to humans, opiate dosing in children must be adjusted depending on history of recurrent hypoxemia to avoid respiratory depression.

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