Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000600011
Brazilian Journal of Anesthesiology
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Importância da avaliação pré-anestésica: relato de caso de paciente com apneia obstrutiva do sono

Importance of pre-anesthetic evaluation: case report of a patient with obstructive sleep apnea

Raquel Reis Soares; Friederike Wolff Valadares; Marta Beatriz Araujo; Michele Nacur Lorentz

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Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo deste relato foi mostrar a importância da avaliação pré-anestésica na redução da morbimortalidade de pacientes cirúrgicos e alertar para os problemas e cuidados anestésicos associados com apneia obstrutiva do sono. RELATO DO CASO: Paciente masculino, 28 anos, obeso classe II, asmático, portador de apneia do sono, hipertenso, encaminhado ao ambulatório de pré-anestésico para avaliação de cirurgia de uvuloplastia sob anestesia geral. Após orientação sobre a apneia obstrutiva do sono, esclarecimento ao paciente quanto os riscos do procedimento e discussão com o cirurgião, optou-se por rever a indicação cirúrgica e adiar o procedimento. CONCLUSÕES: O ambulatório de pré-anestésico é de máxima importância na redução da morbimortalidade do paciente cirúrgico e, principalmente, na avaliação de pacientes com apneia obstrutiva do sono, revelando-se fundamental para a programação anestésico-cirúrgica, orientando condutas a serem tomadas e interferindo positivamente no prognóstico do paciente.

Palavras-chave

ANESTESIA, ANALGÉSICOS, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: The objective of this report was to show the importance of pre-anesthetic assessment in reducing morbidity and mortality of surgical patients and alert to problems and anesthetic care associated with obstructive sleep apnea. CASE REPORT: This is a 28-year old male patient with class II obesity, sleep apnea, hypertension, referred to the pre-anesthetic outpatient clinic for evaluation of uvuloplasty under general anesthesia. After orientation on sleep apnea, explaining to the patient the risks associated with the procedure, and discussing with the surgeon, we decided to review the surgical indication and postpone the procedure. CONCLUSIONS: The pre-anesthetic outpatient clinic is extremely important in reducing morbidity as well as mortality of surgical patients and, especially, in evaluating patients with obstructive sleep apnea, showing to be fundamental for the anesthetic-surgical schedule, orienting conducts to be followed, and interfering positively on patient prognosis.

Keywords

Anesthesia, Sleep Apnea, Analgesics

Referências

Manual Diagnóstico e Estatístico dos Transtornos Mentais. 1994.

Ip M, Mokhlesi B. Sleep and glucose intolerance/diabetes mellitus. Sleep Med Clin. 2007;2:19-29.

Spiegel K, Leproult R, L'Hermitage-Baleriaux , Copinschi G, Penev PD, Van Cauter E. Leptin levels are dependent on sleep duration: relationship with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab. 2004;89:5762-5771.

Kato M, Phillips BG, Sigurdsson G, Narkiewicz K, Pesek CA, Somers VK. Effects of Sleep Deprivation on Neural Circulatory Control. Hypertension. 2000;35:1173-1175.

Spiegel K, Tasali E, Leproult R, Van Cauter E. Effects of poor and short sleep on glucose metabolism and obesity risk. Nat Rev Endocrinol. 2009;5:253-261.

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep disordered breathing among middle aged adults. N Eng J Med. 1993;328:1230-1235.

Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14:486-495.

Youg T, Finn L. Epidemiological insights into the public health burden of sleep disordered breathing: sex differences in survival among sleep clinic patients. Thorax. 1998;53:S16-S19.

Gross JB, Bachenberg KL, Benumof JL. Practice guidelines for perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists task force on perioperative management of patients with obstructive sleep apnea. Anestesiology. 2006;104:1081-1093.

Chung F, Yegeneswaran B, Liao P. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:8128-21.

Chung F, Yegeneswaran B, Liao P. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108:822-830.

Bernards CM, Knowlton SL, Schmidt DF. Respiratory an sleep effects of remifentanil in volunteers with moderate obstructive sleep apnea. Anesthesiology. 2009;110:41-49.

Chung S, Yuan H, Chung F. A systematic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth Analg. 2008;107:1543-1563.

Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc. 2001;76:897-905.

Ramachandran SK, Kheterpal S, Consens F. Derivation and validation of a simple perioperative sleep apnea prediction score. Anesth Analg. 2010;110:1007-1015.

Becker HF, Koehler U, Stammnitz A, Peter J. Heart block in patients with obstructive sleep apnoea. Thorax. 1998;53:S29-S32.

Isono S. Obstructive sleep apnea of obese adults: pathophysiology and perioperative airway management. Anesthesiology. 2009;110:908-921.

Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important?. Cur Opinion in Anesthesiology. 2009;22:405-411.

Taylor S, Kirton OC, Staff I, Kozol RA. Postoperative day one: a high risk period for respiratory events. Am J Surg. 2005;190:752-756.

Vasu TS, Doghramji K, Cavallazzi R. Obstructive sleep apnea syndrome and postoperative complications: clinical use of STOP-BANG questionnaire. Arch Otolaryngol Head and Neck Surg. 2010;136:1020-1024.

Gafsou B, Marsac L, Fournier JL, Béloucif S, Baillard C. Validation of STOP-BANG questionnaire as screening tools for obstructive sleep apnea in patients scheduled for bariatric surgery: 1AP3-5. Anesthesiology. 2008;108:812-821.

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