sleep apnea in ASC

[fastosprintini]

ok, gentlemen, please let this post not degenerate in personal fights...
here's the question ; our ASC is physician owned , i'm a share holder so we all are interested in plenty business, but have frequent disagreements about the handling of OSA. we drew an arbitrary line at a BMI of 37 , above that we want to see them in person for a preop anesthesia review, above 45 we do not do them at all unless it's regional with minimal sedation. sadly we often have to admit them postop because the spinal did'nt work out or the sedation was not minimal...
some have sleepstudies done, others have them not , often the results are equivocal with out a good handle on clinical management.
does somebody here have any coherent thoughts that actually work in practice? thaks for your input, fasto

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[Noyac]

There is a lot to talk about here but I'll try to keep it as short as possible.
Sleep Studies: Apnea/hypopnea index, # of events in 1 hr. 5-15 mild, 16-30 moderate, >30 severe.

We use a scoring system:
Severity of OSA:
none= 0 pts
mild= 1
mod= 2
sev= 3
Subtract 1 pt for pre and post- op CPAP/NIPPVuse.
Add 1 pt if PaCO2 is >/= 50

Surgery - Anesthesia - Pts
superficial - local/block w/o sedation - 0
superficial - mod sedation/GA - 1
peripheral -neuraxial bl/min sed - 1
peripheral -GA - 2
airway - mod sedation - 2
airway - GA - 3
major - GA - 3

Post-op opiod requirement-pts
none 0
low-dose oral 1
high-dose oral/parenteral 3
neuraxial opiod 3

The overall score equals the severity of the OSA score plus the higher of the surgical or post-op opiod score. A score of 5 or> indicates a significant increase in risk and are not candidates for surgery at a freestading surgical facility. A score of 4 indicates increased risk and the following resources are needed; difficult airway equip, resp. care equip (nebs, CPAP AND Vent), portable CXR, lab capability for ABG, and hosp. transfer arrangement.

The OSA task force opinion is that you should not perform upper abd laproscopic surgery including lap chole's on a pt with OSA.

For more info, check out: Outpatient Surgery Magazine, July 2006. Title of the article is: Can You Tell Who Has Obstructive Sleep Apnea?