Upper airway, obstructive sleep apnea, and anesthesia
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The tendencies to upper airway obstruction during sleep and anesthesia are related. Loss of consciousness in either state increases upper airway collapsibility and anesthesia-related suppression of rousability confers great vulnerability to its effects. This vulnerability increases perioperative risk of obstruction in patients with predisposed airways, such as those with obstructive sleep apnea. This risk diminishes with emergence from anesthesia and return of arousal responses but is likely to recur with postoperative sedation/narcotics. It can be adversely influenced by individual drug sensitivities, posture, postsurgical upper airway edema/hematoma, or hypoventilation/hypercapnia. Close postoperative observation is required until consistent rousability returns.
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Hillman, D.; Platt, P.; Eastwood, Peter (2010)Anesthesia and sleep both predispose to upper airway obstruction through state-induced reductions in pharyngeal dilator muscle activation and lung volume. The tendencies are related in patients with obstructive sleep apnea ...
Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofolHillman, D.; Walsh, J.; Maddison, K.; Platt, P.; Kirkness, J.; Noffsinger, W.; Eastwood, Peter (2009)Background: Upper airway collapsibility is known to increase under anesthesia. This study assessed how this increase in collapsibility evolves during slow Propofol induction and how it relates to anesthesia-induced changes ...
Shepherd, K.; Hillman, D.; Holloway, R.; Eastwood, Peter (2011)Purpose: Obstructive sleep apnea (OSA) is associated with increased nocturnal gastroesophageal reflux (nocturnal GER) events and symptoms. Treatment of OSA with continuous positive airway pressure (CPAP) reduces nocturnal ...