Perioperatives Management bei Patienten mit schlafbezogenen Atmungsstörungen

Zusammenfassung

Patienten mit schlafbezogenen Atmungsstörungen (SBAS) stellen innerhalb des operativen Gesamtkollektivs eine besondere Risikogruppe dar und sind während der perioperativen Phase in zwei von einander unabhängigen Perioden vital gefährdet. Während sich in der postoperativen Frühphase noch Überhänge von Narkosesubstanzen negativ auf die Atemarbeit auswirken, wird die postoperative Spätphase besonders durch Veränderungen des REM-Schlafanteils in der Nacht und damit assoziierten Herz-Kreislaufdysregulationen charakterisiert. Um ein sicheres perioperatives Management von Patienten mit SBAS gewährleisten zu können, müssen lückenloses Monitoring (O₂-Sättigung und pCO₂) sowie die Möglichkeit der postoperativen nicht-invasiven Beatmung garantiert werden.

Abstract

Sleep-related breathing disorders have been associated with increased perioperative morbidity and mortality. The respective patients are at risk during two independent periods. Besides an early period, characterised by the influence of anaesthetics, patients are at risk also during a late period, which is characterised by nocturnal desaturation and disturbances of the cardiovascular system, caused by interference with the sleep architecture, especially of the REM sleep. To assure a safe perioperative management, a close monitoring (O₂ saturation and pCO₂) and the option for non-invasive ventilation have to be guaranteed.

Literatur

• 1 Schönhofer B, Kuhlen R, Neumann P. et al . Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz.  Pneumologie. 2008;  62 449-479
• 2 Lavie P, Silverberg D, Oksenberg A, Hoffstein V. Obstructive sleep apnea and hypertension: from correlative to causative relationship.  J Clin Hypertens (Greenwich). 2001;  3 296-301
• 3 Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study.  BMJ. 2000;  320 479-482
• 4 Bradley T D, Floras J S. Sleep apnea and heart failure: Part II: central sleep apnea.  Circulation. 2003;  107 1822-1826
• 5 Bradley T D, Floras J S. Sleep apnea and heart failure: Part I: obstructive sleep apnea.  Circulation. 2003;  107 1671-1678
• 6 Caples S M, Garcia-Touchard A, Somers V K. Sleep-disordered breathing and cardiovascular risk.  Sleep. 2007;  30 291-303
• 7 Arzt M, Young T, Finn L. et al . Association of sleep-disordered breathing and the occurrence of stroke.  Am J Respir Crit Care Med. 2005;  172 1447-1451
• 8 Culebras A. Sleep apnea and stroke.  Rev Neurol Dis. 2005;  2 13-19
• 9 Wierzbicka A, Rola R, Wichniak A. et al . The incidence of sleep apnea in patients with stroke or transient ischemic attack.  J Physiol Pharmacol. 2006;  57 385-390
• 10 Bixler E O, Vgontzas A N, Lin H M. et al . Prevalence of sleep-disordered breathing in women: effects of gender.  Am J Respir Crit Care Med. 2001;  63 608-613
• 11 Kaw R, Michota F, Jaffer A. et al . Unrecognized sleep apnea in the surgical patient: implications for the perioperative setting.  Chest. 2006;  129 198-205
• 12 Parati G, Lombardi C, Narkiewicz K. Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk.  Am J Physiol Regul Integr Comp Physiol. 2007;  293 R1671-R1683
• 13 Chung S A, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologists.  Anesth Analg. 2008;  107 1543-1563
• 14 Yumino D, Bradley T D. Central sleep apnea and Cheyne-Stokes respiration.  Proc Am Thorac Soc. 2008;  5 226-236
• 15 Smetana G W, Lawrence V A, Cornell J E. American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians.  Ann Intern Med. 2006;  144 581-595
• 16 Qaseem A, Snow V, Fitterman N. et al . Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians.  Ann Intern Med. 2006;  144 575-580
• 17 Mogri M, Khan M I, Grant B J, Mador M J. Central sleep apnea induced by acute ingestion of opioids.  Chest. 2008;  133 1484-1488
• 18 Bailey P L, Pace N L, Ashburn M A. et al . Frequent hypoxemia and apnea after sedation with midazolam and fentanyl.  Anesthesiology. 1990;  73 826-830
• 19 Eastwood P R, Platt P R, Shepherd K. et al . Collapsibility of the upper airway at different concentrations of propofol anesthesia.  Anesthesiology. 2005;  103 470-477
• 20 Eikermann M, Malhotra A, Fassbender P. et al . Differential effects of isoflurane and propofol on upper airway dilator muscle activity and breathing.  Anesthesiology. 2008;  108 897-906
• 21 Moote C A, Knill R L. Isoflurane anesthesia causes a transient alteration in nocturnal sleep.  Anesthesiology. 1988;  69 327-331
• 22 Juvin P, Vadam C, Malek L. et al . Postoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study.  Anesth Analg. 2000;  91 714-719
• 23 Gupta R M, Parvizi J, Hanssen A D. et al . 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
• 24 Hwang D, Shakir N, Limann B. et al . Association of sleep-disordered breathing with postoperative complications.  Chest. 2008;  133 1128-1134
• 25 Reeder M K, Muir A D, Foëx P. et al . Postoperative myocardial ischaemia: temporal association with nocturnal hypoxaemia.  Br J Anaesth. 199;  67 626-631
• 26 Aakerlund L P, Rosenberg J. Postoperative delirium: treatment with supplementary oxygen.  Br J Anaesth. 1994;  72 286-290
• 27 Rosenberg J, Oturai P, Erichsen C J. et al . Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia.  J Clin Anesth. 1994;  6 212-216
• 28 Steen P A, Tinker J H, Tarhan S. Myocardial reinfarction after anesthesia and surgery.  JAMA. 1978;  239 2566-2570
• 29 Stradling J R, Crosby J H. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men.  Thorax. 1991;  46 85-90
• 30 Rosenberg-Adamsen S, Kehlet H. et al . Postoperative sleep disturbances: mechanisms and clinical implications.  Br J Anaesth. 1996;  76 552-559
• 31 Knill R L, Moote C A, Skinner M I. et al . Anesthesia with abdominal surgery leads to intense REM sleep during the first postoperative week.  Anesthesiology. 1990;  73 52-61
• 32 Cohen R M, Pickar D, Garnett D. et al . REM sleep suppression induced by selective monoamine oxidase inhibitors.  Psychopharmacology. 1982;  78 137-140
• 33 Kavey N B, Ahshuler K Z. Sleep in herniorrhaphy patients.  Am J Surg. 1979;  138 683-687
• 34 Hallowell P T, Stellato T A, Schuster M. et al . Potentially life-threatening sleep apnea is unrecognized without aggressive evaluation.  Am J Surg. 2007;  193 364-367
• 35 Sharma S K, Kurian S, Malik V. et al . A stepped approach for prediction of obstructive sleep apnea in overtly asymptomatic obese subjects: a hospital based study.  Sleep Med. 2004;  5 351-357
• 36 Shaw I R, Lavigne G, Mayer P. et al . Acute intravenous administration of morphine perturbs sleep architecture in healthy pain-free young adults: a preliminary study.  Sleep. 2005;  28 677-682
• 37 Blake D W, Chia P H, Donnan G. et al . Preoperative assessment for obstructive sleep apnoea and the prediction of postoperative respiratory obstruction and hypoxaemia.  Anaesth Intensive Care. 2008;  36 379-384
• 38 Davies R J, Ali N J, Stradling J R. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome.  Thorax. 1992;  47 101-105
• 39 Gali B, Whalen F X, Gay P C. et al . Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome.  J Clin Sleep Med. 2007;  3 582-588
• 40 Hoffstein V, Szalai J P. Predictive value of clinical features in diagnosing obstructive sleep apnea.  Sleep. 1993;  16 118-122
• 41 Hoffstein V, Mateika S. Differences in abdominal and neck circumferences in patients with and without obstructive sleep apnoea.  Eur Respir J. 1992;  5 377-381
• 42 Sharma S K, Vasudev C, Sinha S. et al . Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome.  Indian J Med Res. 2006;  124 281-290
• 43 Netzer N C, Stoohs R A, Netzer C M. et al . Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.  Ann Intern Med. 1999;  131 485-491
• 44 Kaw R, Aboussouan L, Auckley D. et al . Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.  Obes Surg. 2008;  18 134-138
• 45 Benumof J L. Obesity, sleep apnea, the airway and anesthesia.  Curr Opin Anaesthesiol. 2004;  17 21-30
• 46 Benumof J L. Obstructive sleep apnea in the adult obese patient: implications for airway management.  Anesthesiol Clin North America. 2002;  20 789-811
• 47 Hiremath A S, Hillman D R, James A L. et al . Relationship between difficult tracheal intubation and obstructive sleep apnoea.  Br J Anaesth. 1998;  80 606-611
• 48 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin . Leitlinie Airway Management.  Anästh Intensivmed. 2004;  45 302-306
• 49 Gross J B, Bachenberg K L, Benumof J L. et al . American Society of Anesthesiologists Task Force on Perioperative Management. Practice guidelines for the 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.  Anesthesiology. 2006;  104 1081-1093
• 50 Deutsche G esellschaft. Leitlinie zur postoperativen Überwachung.  Anästh Intensivmed. 1989;  39 202-203
• 51 Janssens J P, Laszlo A, Uldry C. et al . Non-invasive (transcutaneous) monitoring of PCO2 (TcPCO2) in older adults.  Gerontology. 2005;  51 174-178
• 52 Janssens J P, Howarth-Frey C, Chevrolet J C. et al . Transcutaneous PCO2 to monitor noninvasive mechanical ventilation in adults: assessment of a new transcutaneous PCO2 device.  Chest. 1998;  113 768-773
• 53 Senn O, Clarenbach C F, Kaplan V. et al . Monitoring carbon dioxide tension and arterial oxygen saturation by a single earlobe sensor in patients with critical illness or sleep apnea.  Chest. 2005;  128 1291-1296
• 54 Liu S S, Block B M, Wu C L. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis.  Anesthesiology. 2004;  101 153-161
• 55 Lundstrøm L H, Nygård E, Hviid L B. et al . The effect of thoracic epidural analgesia on the occurrence of late postoperative hypoxemia in patients undergoing elective coronary bypass surgery: a randomized controlled trial.  Chest. 2005;  128 1564-1570
• 56 Lawrence V A, Cornell J E, Smetana G W;. American College of Physicians . Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians.  Ann Intern Med. 2006;  144 596-608
• 57 Arisaka H, Sakuraba S, Kobayashi R. et al . Perioperative management of obstructive sleep apnea with nasal continuous positive airway pressure.  Anesth Prog. 2008;  55 121-123
• 58 Arzt M, Wensel R, Montalvan S. et al . Effects of dynamic bilevel positive airway pressure support on central sleepapnea in men with heart failure.  Chest. 2008;  134 61-66
• 59 Naughton M T, Lorenzi-Filho G. Sleep in heart failure.  Prog Cardiovasc Dis. 2009;  51 339-349
• 60 Alattar M A, Scharf S M. Opioid-associated central sleep apnea: a case series.  Sleep Breath. 2008;  Sep 20 [Epub ahead of print]