Evaluation of upper airway during perioperative period in patients with obstructive sleep apnea hypopnea syndrome

doi:10.3969/j.issn.1006-7795.2013.05.002

Abstract

Abstract:

Objective Obstructive sleep apnea hypopnea syndrome (OSAHS) is a severe respiratory sleep disorder, with repeated episodes of nocturnal apnea and hypoxemia as the main clinical features. This study aimed to observe the characteristics of upper airway collapse under general anesthesia with muscle relaxation to provide evidences for better perioperative airway management.MethodsThirty male cases, who met the diagnostic criteria by polysomnography (PSG) for OSAHS, and received elective uvulopalatopharyngoplasty. Vecuronium (0.08 mg/kg) was given to achieve complete muscle relaxation after the nasal endotracheal intubation was achieved with slow induction. The image workstation with fiberscope was used to observe the pharynx cavity and record images. The cavity pressure, which represents the passive collapse of the airway and can just open the soft palate pharyngeal cavity, was analyzed. The correlation of the graphics and data with sleep monitoring indicators were analyzed.Results All patients were successfully operated on with no accidents and perioperative complications. The body mass index (BMI) was (28.39±3.99) kg/m². The apnea hypopnea index (AHI) was (52.3±23.8) times/h. The supine AHI (AHIs) was (68.9±23.6) times/h. The minimum nocturnal pulse oxygen saturation was (72.5±9.3)%. With full muscle relaxation, in 1 case (3.3%) the upper airway was completely collapsed at the flat of hard palate. The flat of soft palate and uvula completely collapsed in all patients (100%). The tongue pharynx plane collapsed in 23 patients (76.7%). The median critical opening pressure of post soft palate was 8.3 (5.9, 11.5) cm H₂O (1 cm H₂O=0.098 kPa). It was positively correlated with AHI (r= 0.377,P= 0.040). Conclusion The abnormalities of the airway passive collapse in OSAHS patients increase. The perioperative risk of serious respiratory tract obstruction is high. Retropalatal and retroglossal airway are the most collapsible segments. If the airway completely collapses and the positive ventilation is not improved with oropharyngeal airway, the use of nasopharyngeal airways should be considered. The individualized airway assessment can improve the perioperative security for OSAHS patients. The critical opening pressure was positively correlated with AHI, especially with AHIs. Therefore the critical opening pressure can be estimated to guide clinical practice.

Key words: obstructive sleep apnea hypopnea syndrome(OSAHS), airway, pharynx, pressure, anesthesia

CLC Number:

R246.2

LIN Na, LI Yanru, LI Tianzuo, ZHANG Bingxi, YE Jingying. Evaluation of upper airway during perioperative period in patients with obstructive sleep apnea hypopnea syndrome[J]. Journal of Capital Medical University, 2013, 34(5): 646-650.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2013.05.002

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2013/V34/I5/646

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