Gastric POCUS, 3-Part Episode

This is a challenging question that few people answer correctly! Most anesthesiologists are not familiar with the Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. A STOP-BANG score of 5 or greater carries a 35% risk of the patient having severe obstructive sleep apnea. Patients with obstructive sleep apnea have an increased risk of difficult intubation, postoperative mechanical ventilation, and adverse cardiopulmonary events. Thus, patients should be screened preoperatively for obstructive sleep apnea. If a patient scores greater than or equal to 5 on the STOP-BANG score, it is recommended that the anesthesiologist treat the patient as though they have been diagnosed with obstructive sleep apnea (e.g. limit opioids). Patients with obstructive sleep apnea are at much higher risk for adverse perioperative events if significant opioid analgesia is administered. There is no clear data at this point to suggest that performing a formal sleep study and being prescribed continuous positive airway pressure (CPAP) actually reduces the morbidity and mortality of these patients. Additionally, it is unknown how long a patient should comply with their CPAP prior to elective surgery in order to minimize perioperative risk.