April 25, 2024
Growing demand for anesthesia services at ASCs is being met with a dwindling supply of anesthesia providers....
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By: Mary Alfonso, Ha Eun Won
Published: 4/8/2021
Obstructive sleep apnea (OSA) is a common disorder affecting approximately one in four adults. It's also often undiagnosed — 90% of people with OSA don't know they have it — and undertreated. Failure to appropriately assess patients for the disorder increases the risk of complications during and after surgery, including prolonged recovery and, worse, adverse respiratory events.
We had been using the STOP — Snoring, Tiredness, Observed Apnea and Pressure (hypertension) — tool to assess patients for OSA before they underwent endoscopy cases. One patient who we identified as having OSA was still heavily sedated after a procedure. Over-sedation can lead to respiratory depression or compromise and the patient's condition can quickly deteriorate. That caused us to take a second look at the protocols we had in place to assess patients for OSA as well as the steps we take to keep them safe.
After some research, we realized the STOP tool collects only subjective data. For example, many patients aren't aware they snore when they're asleep. By adding "Bang" (BMI, Age, Neck Circumference and Gender) to the questionnaire, we were able to identify more patients who presented with OSA. When a patient is appropriately screened for OSA and exhibits signs of complication risks, providers can implement interventions that lead to safer procedures.
During the procedure, anesthesia providers use a multi-port capnography mask, which allows for preoxygenation of the patient and easy access to the nose and mouth. It also has a capnography sampling port for continuous monitoring of the patient's end-tidal CO2. Anesthesia providers are prepared to employ the head-tilt-jaw-lift technique and ensure adjunct airways are readily available in the event the patient's airway becomes obstructed.
We reviewed endoscopy patients' charts for the months of September, October and November 2020, comparing their OSA risk assessments using the STOP and the STOP-Bang tools. The review revealed we identified only 6.7% of high-risk patients using the STOP assessment, versus 54.9% of high-risk patients with the STOP-Bang questionnaire. By asking four additional questions during pre-procedure screenings, we now provide safer care and alert some patients to a health risk they might not know they had. OSM
The STOP-Bang questionnaire includes eight questions that help identify patients with obstructive sleep apnea. Patients who answer 'yes' to at least five of the eight questions are at increased risk of airway complications. This risk-assessment can be completed quickly and easily before procedures.
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