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Intraoperative management of adults with obstructive sleep apnea

Eric Olson, MD
Frances Chung, MBBS, FRCPC
Edwin Seet, MBBS, MMed
Section Editors
Stephanie B Jones, MD
Nancy Collop, MD
Deputy Editors
Marianna Crowley, MD
Geraldine Finlay, MD


Obstructive sleep apnea (OSA) is a disorder characterized by repetitive episodes of apnea or reduced inspiratory airflow due to upper airway obstruction during sleep. OSA is the most common type of sleep-disordered breathing, with an estimated prevalence of 1 in 4 males and 1 in 10 females for mild OSA, and 1 in 9 males and 1 in 20 females for moderate OSA [1]. OSA has been increasing in prevalence over the last two decades in parallel with the increase in obesity [2-5]. Over half of patients with OSA who present for surgery are undiagnosed [6,7].

The incidence of perioperative complications is greater in patients with OSA [8-11], leading the American Society of Anesthesiologists, the American Academy of Sleep Medicine, and others to develop clinical practice guidelines and protocols for the perioperative management of patients with OSA [3,12-14]. Recommendations include maintaining a high index of suspicion for OSA, careful use of medications, vigilant monitoring for upper airway obstruction, and an integrated team approach to perioperative management. There is little direct evidence that these precautions improve outcomes, so recommendations are generally based upon indirect evidence, clinical rationale, and expert opinion.

The intraoperative management of patients with OSA is reviewed here, using risk mitigation strategies and precautions. This includes determining whether the surgery should be performed on an inpatient or outpatient basis, anesthesia techniques, premedication, and airway management. The increase in perioperative complications, preoperative evaluation and management, and postoperative management of patients with OSA are discussed separately. (See "Surgical risk and the preoperative evaluation and management of adults with obstructive sleep apnea" and "Postoperative management of adults with obstructive sleep apnea".)


In general, the choice of anesthetic technique is determined by the surgical procedure and preferences of the patient, anesthesiologist, and surgeon. Patient-related factors such as airway concerns and high levels of anxiety also influence the choice of technique.

In obstructive sleep apnea (OSA), a general principle is to use an anesthetic technique that minimizes the use of respiratory depressants whose effects will continue into the postoperative period. Most anesthetic techniques can be modified to conform to this goal.

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Literature review current through: Nov 2017. | This topic last updated: Oct 11, 2016.
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