Ravesloot, Madeline J. L., de Raaff, Christel A. L., van de Beek, Megan J., Benoist, Linda B. L., Beyers, Jolien, Corso, Ruggero M., Edenharter, Guenther, den Haan, Chantal, Azad, Jacqueline Heydari, Ho, Jean-Pierre T. F., Hofauer, Benedkt, Kezirian, Eric J., van Maanen, J. Peter, Maes, Sabine, Mulier, Jan P., Randerath, Winfried, Vanderveken, Olivier M., Verbraecken, Johan, Vonk, Patty E., Weaver, Edward M. and de Vries, Nico (2019). Perioperative Care of Patients With Obstructive Sleep Apnea Undergoing Upper Airway Surgery A Review and Consensus Recommendations. JAMA Otolaryngol-Head Neck Surg., 145 (8). S. 751 - 761. CHICAGO: AMER MEDICAL ASSOC. ISSN 2168-619X

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Abstract

IMPORTANCE To date, no consensus exists regarding optimal perioperative care of patients with obstructive sleep apnea (OSA) undergoing upper airway (UA) surgery. These patients are at risk related to anesthesia and postoperative analgesia, among other risks associated with difficult airway control, and may require intensified perioperative management. OBJECTIVE To provide a consensus-based guideline by reviewing available literature and collecting expert opinion during an international consensus meeting with experts from relevant speciliaties. EVIDENCE REVIEW In a consensus meeting conducted on April 4, 2018, a total of 47 questions covering preoperative, intraoperative, and postoperative care were formulated by 12 international experts with extensive clinical experience in the field of UA surgery for OSA. Systematic literature searches were performed by an independent information specialist and 6 researchers according to the Oxford and GRADE systems, and 164 articles published on or before December 31, 2011, were included in the analysis. Two moderators chaired the meeting according to the Amsterdam Delphi Method, including iteration of literature conclusions, expert discussion, and voting rounds. Consensus was reached when there was 70% or more agreement among experts. FINDINGS Of 47 questions, 35 led to a recommendation or statement. The remaining 12 questions provided no additional information and were excluded in the judgment of experts. Consensus was reached for 32 recommendations. For 1 question there was less than 70% agreement among experts; therefore, consensus was not achieved. Highlights of these recommendations include (1) postoperative bleeding is a complication described for all types of UA surgery; (2) OSA is a relative risk factor for difficult mask ventilation and intubation, and plans for difficult airway management should be considered and implemented; (3) safe perioperative care should be provided, with aspects such as OSA severity, adherent use of positive airway pressure, type of surgery, and comorbidities taken into account; (4) although there is no direct evidence to date, in patients undergoing UA surgery, preoperative treatment with positive airway pressure may reduce the risk of postoperative airway complications; and (5) alternative pain management options perioperatively to reduce opioid use should be considered. CONCLUSIONS AND RELEVANCE This consensus contains 35 recommendations and statements on the perioperative care of patients with OSA undergoing UA surgery and may be used as a guideline in daily practice.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Ravesloot, Madeline J. L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Raaff, Christel A. L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van de Beek, Megan J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Benoist, Linda B. L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beyers, JolienUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Corso, Ruggero M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Edenharter, GuentherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
den Haan, ChantalUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Azad, Jacqueline HeydariUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ho, Jean-Pierre T. F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hofauer, BenedktUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kezirian, Eric J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Maanen, J. PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maes, SabineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mulier, Jan P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Randerath, WinfriedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vanderveken, Olivier M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Verbraecken, JohanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vonk, Patty E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weaver, Edward M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Vries, NicoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-145362
DOI: 10.1001/jamaoto.2019.1448
Journal or Publication Title: JAMA Otolaryngol-Head Neck Surg.
Volume: 145
Number: 8
Page Range: S. 751 - 761
Date: 2019
Publisher: AMER MEDICAL ASSOC
Place of Publication: CHICAGO
ISSN: 2168-619X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
POSTOPERATIVE OUTCOMES; BARIATRIC SURGERY; RISK-FACTORS; TASK-FORCE; MANAGEMENT; COMPLICATIONS; PRESSURE; UVULOPALATOPHARYNGOPLASTY; ADVANCEMENT; ANESTHESIAMultiple languages
Otorhinolaryngology; SurgeryMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/14536

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