Sleep-related breathing disorders (SDB); It can be defined as a spectrum of diseases consisting of snoring, upper airway resistance syndrome and obstructive sleep apnea (OSA). It is reported that SDB is seen in 24% of men and 9% of women. It is known that most SDB patients remain undiagnosed. 93% of female patients and 82% of male patients with moderate-severe OSA have not been diagnosed. It is well documented that OSA has serious effects on the cardiovascular and respiratory systems and on neurocognitive functions. It has been shown that there is a strong relationship between SDB and hypertension. This is thought to be due to sleep disruption, hypoxemia (decreased blood oxygen level) and increased sympathetic tone at night.
TUA patients have a high risk of encountering airway problems when they undergo surgery. The reason for this is that these cases are difficult for the anesthetist due to their small mandible, large tongue, and short and thick neck structures. Additionally, OSA cases are very sensitive to muscle relaxants and narcotic analgesics. Respiratory depression and recurrent apneas may occur while waking up from anesthesia. Respiratory suppression lasting 4-12 hours may occur after using narcotic analgesics. Laryngeal edema has been reported at a rate of 5.7% in some series. This situation can be overcome with prophylactic steroid use.
Patients with an apnea index (AI) higher than 70 and a nadir oxygen concentration lower than 80% are at higher risk for postoperative complications, especially oxygen saturation drops. .
In a study evaluating 1698 surgical procedures performed on 487 patients, the overall complication rate was found to be 7.1%. The breakdown of complications is as follows:
- Bleeding problems (3.1%): 7-15 days after surgery. developed between days. 8 out of 15 patients had to be taken to the operating room. None of them required blood transfusion. It was determined that one of the cases used gingko biloba and the other used aspirin.
- Permanent hypertension (3.1%): All of these patients had preoperative hypertension.
- Swollen tongue (1.8%): In all cases, it occurred due to tongue suspension sutures.
- Decrease in oxygen saturation. Chills (1.2%): It occurred in the first 180 minutes postoperatively in all patients.
- Pulmonary edema due to negative pressure (0.4%): It is due to biting the tube during inspiration while waking up from anesthesia. Intravascular fluid is drawn into the alveoli.
- Airway obstruction (0.2%): It developed on the 2nd postoperative day in a case where only one nose, palate and tongue surgery was performed together, after bleeding started at the floor of the mouth following a heavy cough. . He was urgently intubated nasoendotracheally and remained intubated under sedation for 3 days.
- Nasopharyngeal stenosis: It was not observed in any case.
All TSA cases were observed for at least 3 hours after surgery. should be kept under intense surveillance for a period of time. Perioperative use of CPAP (continuous positive airway pressure) is recommended to reduce postoperative respiratory problems. The first group of patients in this study were those in whom nose and palate surgery was performed in a single session. This group of patients was kept in the hospital for at least 6 hours after surgery. The second group of patients were subjected to nose, palate and tongue surgery and were followed in the hospital for at least one night.
You can access the entire article from the link below (Pang KP, et al. Arch Otolaryngol Head Neck Surg 2012;138:353 -7).
SAFETY OF SURGERY
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