Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2017.11.006
Brazilian Journal of Anesthesiology
Scientific Article

Correlation between obstructive apnea syndrome and difficult airway in ENT surgery

Correlação entre síndrome da apneia obstrutiva e via aérea difícil na cirurgia otorrinolaringológica

Marcia Hiray Pera; Maria Angela Tardelli; Neil Ferreira Novo; Yara Juliano; Helga Cristina Almeida da Silva

http://dx.doi.org/10.1016/j.bjane.2017.11.006 Braz J Anesthesiol, vol.68, n6, p.543-548, 2018
PDF English
PDF Português
Downloads: 0
Views: 730

Abstract

Abstract Introduction: ENT patients with obstructive sleep apnea syndrome have a tendency of collapsing the upper airways in addition to anatomical obstacles. Obstructive sleep apnea syndrome is related to the increased risk of difficult airway and also increased perioperative complications. In order to identify these patients in the preoperative period, the STOP Bang questionnaire has been highlighted because it is summarized and easy to apply. Objectives: Evaluate through the STOP Bang questionnaire whether patients undergoing ENT surgery with a diagnosis of obstructive sleep apnea syndrome have a higher risk of complications, particularly the occurrence of difficult airway. Casuistry and methods: Measurements of anatomical parameters for difficult airway and questionnaire application for clinical prediction of obstructive sleep apnea syndrome were performed in 48 patients with a previous polysomnographic study. Results: The sample detected difficult airway in about 18.7% of patients, all of them with obstructive sleep apnea syndrome. This group had older age, cervical circumference > 40 cm, ASA II and Cormack III/IV. Patients with obstructive sleep apnea syndrome had higher body mass index, cervical circumference, and frequent apnea. In subgroup analysis, the group with severe obstructive sleep apnea syndrome showed a significantly higher SB score compared to patients without this syndrome or with a mild/moderate obstructive sleep apnea syndrome. Conclusions: The STOP Bang questionnaire was not able to predict difficult airway and mild obstructive sleep apnea syndrome, but it identified marked obstructive sleep apnea syndrome. All patients with difficult airway had moderate and marked obstructive sleep apnea syndrome, although this syndrome did not involve difficult airway. The variables Cormack III/IV and BMI greater than 35 kg.m−2 were able to predict difficult airway and obstructive sleep apnea syndrome, respectively.

Keywords

Sleep apnea syndrome, Oropharynx, Intubation, Risk factors, Surveys and questionnaires

Resumo

Resumo Introdução: Os pacientes cirúrgicos otorrinolaringológicos portadores da síndrome da apneia obstrutiva do sono apresentam, além de obstáculos anatômicos, tendência ao colapso das vias aéreas superiores. Síndrome da apneia obstrutiva do sono está relacionada ao maior risco de via aérea difícil e também aumento de complicações perioperatórias. A fim de se identificar esses pacientes no período pré-operatório, tem se destacado o questionário STOP Bang, por ser resumido e de fácil aplicação. Objetivos: Avaliar se pacientes submetidos à cirurgia otorrinolaringológica com diagnóstico de síndrome da apneia obstrutiva do sono pelo questionário STOP Bang apresentariam maior risco de complicações, particularmente ocorrência de via aérea difícil. Casuística e métodos: Feitas medidas de parâmetros anatômicos para via aérea difícil e administrado questionário para predição clínica de síndrome da apneia obstrutiva do sono em 48 pacientes com estudo polissonográfico prévio. Resultados: A amostra detectou via aérea difícil em 18,7% dos pacientes, todos portadores de síndrome da apneia obstrutiva do sono. Esse grupo apresentava maior idade, circunferência cervical > 40 cm, ASA II e Cormack III/IV. Os pacientes com síndrome da apneia obstrutiva do sono apresentaram maior índice de massa corpórea, circunferência cervical e frequência de apneia observada. Na análise de subgrupos, o grupo com síndrome da apneia obstrutiva do sono acentuada mostrou significantemente maior pontuação no SB quando comparado com pacientes sem síndrome da apneia obstrutiva do sono ou com síndrome da apneia obstrutiva do sono leve/moderada. Conclusões: O questionário STOP Bang não foi capaz de predizer via aérea difícil e nem síndrome da apneia obstrutiva do sono leve e moderada, mas identificou síndrome da apneia obstrutiva do sono acentuada. Todos pacientes com via aérea difícil apresentaram síndrome da apneia obstrutiva do sono moderada e acentuada, apesar desta síndrome não implicar em via aérea difícil. As variáveis Cormack III/IV e IMC maior do que 35 Kg.m-2 foram capazes de predizer via aérea difícil e síndrome da apneia obstrutiva do sono respectivamente.

Palavras-chave

Síndromes da apneia do sono, Orofaringe, Intubação, Fatores de risco, Pesquisas e questionários

References

Young T, Palta M, Dempsey J. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-5.

Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217-39.

Gottlieb DJ, Yao Q, Redline S. Does snoring predict sleepiness independently of apnea and hypopnea frequency?. Am J Respir Crit Care Med. 2000;162:1512-7.

Pedrosa RP, Lorenzi G, Drager LF. Síndrome da apnéia obstrutiva do sono e doença cardiovascular. Rev Med (São Paulo). 2008;87:121-7.

Punjabi NM, Sorkin JD, Katzel LI. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med. 2002;165:677-82.

Farney RJ, Walker BS, Farney RM. The Stop Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. J Clin Sleep Med. 2011;7:459-465B.

McLean HA. Effect of treating severe nasal obstruction on the severity of obstructive sleep apnoea. Eur Respir J. 2005;25:521-7.

Kushida CA, Littner MR, Hirshkowitz M. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep. 2006;29:375-80.

Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg. 2002;95:1098-102.

Machado C, Yamashita AM, Togeiro SMGP. Anestesia e apneia obstrutiva do sono. Rev Bras Anestesiol. 2006;56:669-78.

Chung F, Yegneswaran B, Liao P. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812-21.

Magalhães E, Marques FO, Govêia CS. Use of simple clinical predictors on preoperative diagnosis of difficult endotracheal intubation in obese patients. Rev Bras Anestesiol. 2013;63:262-6.

American Society of Anesthesiologists Task Force on Management of the Difficult, Airway, Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269-77.

Ito E, Inoue Y. The International Classification of Sleep Disorders, third edition. American Academy of Sleep Medicine. Includes bibliographies and index. Nihon Rinsho. 2015;73:916-23.

Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest. 1993;103:30-6.

Netzer NC, Stoohs RA, Netzer CM. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485-91.

Abrishami A, Khajehdehi A, Chung F. A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anesth. 2010;57:423-38.

Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39:1105-11.

Phelan MP, Sakles JC, Laurin EG. Use of the endotracheal bougie introducer for difficult intubations. Am J Emerg Med. 2004;22:479-82.

Siegel SCJ. Estatística não paramétrica para ciências do comportamento. 2006.

Loadsman JA, Hillman DR. Anaesthesia and sleep apnoea. Br J Anaesth. 2001;86:254-66.

Lee SJ, Lee JN, Kim TS. The relationship between the predictors of obstructive sleep apnea and difficult intubation. Korean J Anesthesiol. 2011;60:173.

Kulkarni GV, Horst A, Eberhardt JM. Obstructive sleep apnea in general surgery patients: is it more common than we think?. Am J Surg. 2014;207:436-40.

Chung F, Subramanyam R, Liao P. High Stop Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108:768-75.

Wilhelm CP, DeShazo RD, Tamanna S. The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol. 2015;115:96-102.

5dcaed160e88255d0503b87a rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections