Correlation Between Obstructive Sleep Apnea

As a clinical requirement for my Adult 1: Medical-Surgical course, I had the opportunity to observe a patient in the Operating Room and in the Post Anesthesia Unit of Advocate Good Samaritan Hospital. The procedure that I observed was a left total knee replacement. The patient needed this surgery because she was experiencing osteoarthritis, and this surgery could alleviate her pain and discomfort. I was with the patient from the end of her stay in the pre-operative holding area to the Operating Room, and then to the Post Anesthesia Care Unit. This paper will include background inquiry, preoperative and operative

On 01/27/2016, I observed about 22 patients in Postanesthesia Care Unit. Some of the patients were observed after surgeries while others were observed after endoscopy. During my shift, I observed patients awaiting recovery for removal of kidney stones, malignant melanoma (removal of moles), Endometrial Biopsy (EBX), superficial femoral artery (SFA), Hernia repair, Oophorectomy (ovary removal surgery), Cardiorrhaphy (Ventricular repair), Cystolithalopaxy (bladder stone removal), gall stone removal, Ectopic pregnancy surgery, and leg surgery.

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

The population who are diagnosed with obstructive sleep apnea (OSA) often experience daytime drowsiness and are at risk for ischemic heart disease, arrhythmias, hypertension, and other vascular related problems (Hsu et al., 2007). There are several treatment options for people with OSA, which are weight loss, continuous positive airway pressure (CPAP), dental appliances, and surgical procedure. This study evaluates patients who have

Enhanced recovery after surgery (ERAS) are a relatively new set of protocols arising in the 1990’s which have since been coined the gold standard in surgical patient care. They have been increasing adopted in because overall research has shown them to be a safe and cost effective way of reducing length of hospital stay and positive patient outcomes. ERAS protocols are threaded throughout the perioperative care, including pre, intra and post-operative phases. I will analysis two research papers which highlight the use of ERAS protocols and define a variety of protocols and focus on four ERAS protocols which are commonly used in surgical nursing.

The procedure might be something simple such as inserting tiny rods in your soft palate that cause it to stiffen so it doesn't collapse when you relax. The surgery could also be very complex, such as repositioning your jaw. However, many of the sleep apnea surgeries involve removing excess tissue. This could be removing adenoids and tonsils or removing excess tissue from the throat, soft palate, or tongue. Some procedures are relatively minor and can be done as an outpatient. Surgeries that involve correcting bone abnormalities may require a hospital

Per the study, the “findings have a few important implications. A substantial minority of patients aged 80 and older who have major noncardiac surgery die or suffer a postoperative complication, but the majority have good outcomes, and for many operations, mortality rates were low (>2%).” The

There is a strong association between obstructive sleep apnea and hypertension, among cardiac conditions such as heart failure, cardiac arrhythmias and coronary heart disease. OSA and hypertension share similar risk factors such as age and obesity, and are commonly co-morbid. During an obstructive sleep apnea episode the patient experiences reduced airflow due to obstruction in the upper airway, leading to hypoxia and hypercapnia, the patient is typically awakened by these episodes. Due to hypoxia, OSA causes an increase in sympathetic activity, endothelial dysfunction and increased oxidative stress. Increase systemic activity leads to an increase in both heart rate and blood pressure. Endothelial dysfunction is an imbalance of vasorelaxation

Developed in 1941, the American Society of Anesthesiologists (ASA) classification was created to establish a scoring system (I to V) for the evaluation of a patient’s general health and comorbidities immediately before an operative procedure. (Sakad, Keats) This score is designed to identify surgical patients at risk for developing postoperative complications, taking into account the patient’s physical state and neglecting the surgical impact (type, complexity and urgency). It has been established as a significant predictive factor for perioperative risk assessment, perioperative mortality, complication rates, and postoperative outcomes in multiple surgical specialties. ( Menke, Wolters, Prause, Conners) Similarly, our data shows a good predictability of mortality by the ASA PS. It has undergone slight modification by the ASA to a scale of 6 numbers and is now widely used for preoperative

We live in a world where we are always on the go. We have projects and deadlines to meet for work. We have kids to pick up after school. We have projects to complete around the house along with the usual cooking of meals and doing laundry. It seems like we burn the midnight oil more times than we don’t. Unfortunately, if you think you can function off of a couple hours of sleep each night, you’re wrong.

Obesity is established as one of the leading risk factors for development of both type 2 diabetes and obstructive sleep Apnea(OSA). Obesity is medically defined as a complex disorder involving an excessive amount of body fat. Clearly, this isn’t just a cosmetic concern. The Body Mass Index (BMI) numerical range is 30.0-34.9 is consider obese (1) 35.0-39.9 obese (2), finally 40.0 above is extreme obesity (3). When it comes to Obesity it normally does not have just one underlining issue. Other factors are cardiovascular disease, and hypertension. Most likely a patient will develop a serious sleeping disorder, one called obstructive sleep apnea(OSA). This causes breathing to repeatedly stop and start during sleep. The throat muscles intermittently relax and block the airway during sleeping. Several signs of sleep apnea exist for example; loud snoring, shorter sleeping duration, poor quality of sleep, high blood pressure, morning headaches, decrease libido, weight gain, and even death due to lack of air. Polysomnography is medically performed to evaluate the presence of OSA and its severity.

Obstructive sleep apnea (OSA) is highly prevalent but very frequently undiagnosed. OSA is an independent risk factor for depression and cognitive impairment/dementia. Herein we reviewed studies in the literature pertinent to the effects of OSA on the cerebral microvascular and neurovascular systems and present a model to describe the key pathophysiological mechanisms that may underlie the associations, including hypoperfusion, endothelial dysfunction, and neuroinflammation. Intermittent hypoxia plays a critical role in initiating and amplifying these pathological processes. Hypoperfusion and impaired cerebral vasomotor reactivity lead to the development or progression of cerebral small vessel disease (C-SVD). Hypoxemia exacerbates these processes,

In this study, we examined whether intraoperative hypothermia in patients undergoing open elective abdominal aortic surgery was predictive of postoperative in-hospital morbidity. We also assessed the magnitude of any such association, adjusted for possible confounders such as age, comorbidities and surgical complexity.

A systematic review undertaken by Smetana (2009) identifies postoperative respiratory failure as an example of cascade iatrogenesis i.e. serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event. In this case, Mrs Hilton’s open cholecystectomy is that first event. Smetana (2009) points out that: when an older patient with postoperative pain is over-sedated, a decline in respiratory function occurs, that if not recognized, can result in respiratory failure that requires mechanical ventilation, that again, if not managed properly can culminate in ventilator-associated pneumonia and even sepsis and death (p.1529). After her upper abdominal surgery Mrs Hilton may have difficulty with deep breathing and coughing due to pain however both are essential interventions for prevention and treatment of respiratory infections and complications. Brown et al. (2008) recommend that when Mrs Hilton is awake, turning, coughing and deep breathing should be encouraged every one to two hours as this aids in the removal of secretions and prevents mucous plugs. They also encourage mobility when possible to increase respiratory excursion. Moreover, as Mrs Hilton

Unfortunate as it may be, postoperative nausea still affects approximately 22% to 38% of people undergoing a surgical procedure (Chandrakantan, 2011). The pathological process associated with nausea and vomiting includes “the central nervous system, autonomic nervous system, gastric dysrhythmias, and the endocrine system” (Singh, Yoon, & Kuo, 2016, p. 100). This activation causes increased activity, which can be unpleasant for the patient particularly after undergoing surgery. A surgical patient who is experiencing postoperative nausea and vomiting (PONV) may have increased risks such as aspiration or choking, increased pain, and delayed healing. In order to possibly reduce these risks, physicians and nurses should be educated on the most up