Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period--avoiding complications.

PURPOSE: To help practitioners avoid adverse perioperative events in patients with obstructive sleep-disordered breathing. REVIEWERS: Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee.
METHODS: A search of MEDLINE database using MeSH terms apnea, obstructive sleep apnea and anesthesia was conducted in October 2001. This review focuses on articles published in English between 1985 and 2001 that pertain to non-upper airway surgery in obstructive sleep apnea patients. RESULTS AND
CONCLUSIONS: Scientific literature regarding the perioperative risk and best management techniques for OSAHS patients is scanty and of limited quality. There is insufficient information to develop an AASM standards of practice recommendation. Therefore, the Clinical Practice Review Committee (CPRC) used the available data to make this statement based upon a consensus of clinical experience and published peer-reviewed medical evidence. Important components of the perioperative management of OSAHS patients include a high degree of clinical suspicion, control of the airway throughout the perioperative period, judicious use of medications, and appropriate monitoring. Further research is needed to define the magnitude of risk and optimal perioperative care.