耳鼻科ジャーナル

Management of Obstructive Sleep Apnea Following Endoscopic Skull Base Surgery

Kevin A Peng, Ashley E Kita, Barbara M Van de Wiele, Jeffrey D Suh, Marvin Bergsneider and Marilene B Wang

Management of Obstructive Sleep Apnea Following Endoscopic Skull Base Surgery

Objective: Obstructive sleep apnea (OSA) is associated with an increased risk for post-operative complications following general anesthesia. In this study, we examine our experience with OSA patients undergoing endoscopic skull base surgery and provide recommendations for management.

Methods: Medical records of patients undergoing endoscopic skull base surgery at a tertiary care center between 2009 and 2013 were reviewed.

Results: Forty-three patients were either previously diagnosed with or were suspected of having OSA. A nasopharyngeal airway was placed under direct endoscopic visualization prior to emergence in 42 patients (98%), and the airway was removed the first postoperative day. One patient experienced apnea and desaturation following transfer to the postanesthesia care unit, but was successfully re-intubated and re-extubated the same day.

Conclusion: The nasal airway of patients with OSA undergoing endoscopic skull base surgery may be compromised by the presence of edema, blood, and surgical packing. In addition, acromegaly and macroglossia in these patients further impacts pharyngeal patency negatively. A careful history and examination can identify patients at risk for OSA. The use of a nasopharyngeal airway in patients with OSA undergoing endoscopic skull base surgery is well-tolerated and safe, and may decrease the incidence of perioperative OSA-related complications.