OSA: Vent management

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of upper airway collapse during sleep that severely limit airflow despite breathing efforts. It has been associated with adverse long-term health outcomes as well as increased perioperative complication risk. In addition to being at risk for difficult airway management, patients with OSA are particularly sensitive to medications used intraoperatively. For example, patients with OSA who receive neuromuscular blocking agents are at increased risk of experiencing significant effects associated with residual neuromuscular blockade including hypoxia and respiratory failure. For this reason, all attempts should be made to avoid neuromuscular blockade including regional anesthesia (when applicable), continuous positive airway pressure (CPAP), and supraglottic airways. Medications that are known to cause respiratory depression (opioids, benzodiazepines, etc.) should be avoided when possible. If invasive mechanical ventilation is absolutely necessary, particular attention should be paid to ensure adequate reversal and extubation to CPAP should be considered. Patients with OSA should have CPAP available in the postanesthesia care unit.