I am among the fortunate to have required general anesthesia only a couple time in my life and the second was after I had become the E.D. of American Sleep Apnea Association. The anesthesiologist, learning of my relationship to the association, came in before the procedure and talked my ear off (in a nice way) about the problem of undiagnosed OSA patients coming in to the ambulatory surgery center and she having to deal with them... meaning not be a party to their sudden or not so sudden demise after administering anesthetics.
It makes complete sense that an anesthesiologist would be concerned about an undiagnosed OSA patient. According to Dr. Johnathan Benumof, whose presentation I attended on Saturday, there are three points at which the anesthesiologist should be concerned about an OSA patient, treated or untreated... intubation - administering the anesthetic too soon may cause the airway to close thereby making it very difficult to put the breathing tube in the throat. Extubation - for the same reason, but in reverse and pain management, post operative... many of the opiod-type pain medicines can suppress breathing and with the OSA patient the problem is compounded.
Dr. Benumof's presentation to a nearly standing room only hall provided an excellent overview to OSA and explained, briefly the guidelines adopted two years ago by the American Society of Anesthesiology on management of the OSA patient.
I was able to attend a clinic forum where the case study was a man who is suspected of having sleep apnea come in to an ambulatory surgical center for repair to his rotator cuff. It was interesting to listen to their discussion, many of whom believed that the surgery, for a number of reasons should be done in a hospital setting where it would be possible to monitor the patient after the surgery... since the surgery itself is not the problem, but the pain management afterwards is.
Dr. Benumof admonished those assembled during his talk that they were likely the last physicians to see the patient and it was their responsibility to make sure they received the proper care. It is very true... on more than one occasion, the surgery has been a success, but the patient dies in the recovery room or "out on the ward" because they were not properly monitored or given the correct analgesia given their diagnosed and not announced or their undiagnosed obstructive sleep apnea.
For those with sleep apnea reading this... please say something before going in for surgery or a procedure requiring anesthetic (think colonoscopy)... click on the links below for more information. If you have not been diagnosed and it is clear from looking at you and asking a couple of telling questions that you are at risk of OSA... you may find yourself diagnosed before you leave the hospital after having surgery. Assuming you leave under your own steam and not feet first.
The conversations in the exhibit hall have centered on our most recent Patient Education Bulletins on CPAP in Hospital and the checklist. Our web site has more information for the anesthesiologist, but looking at it, it needs some work.
There is potential for great synergy with this group of doctors who are very interested in this subject. I will move it high on my list of relationships to explore.
Next week Chicago and the American College of Chest Physicians
PS... found in my fortune cookie after dinner last night... You could make a name for yourself in the field of medicine... nice thought!