Under certain extreme circumstances, it may be prudent to have an experienced surgeon available in the operating room at the time of induction of general anesthesia in case tracheostomy becomes necessary. Regardless of the primary anesthetic technique chosen, airway maintenance, especially with sedation, remains a fundamental concern to the anesthesiologist. In patients who have just undergone surgery for the treatment of their OSA, the airway can be narrowed from swelling and inflammation. Also, the lingering sedative and ventilatory depressant effects of the anesthetic can pose difficulty. Perioperative vigilance should continue into the postoperative period.
Many patients require postoperative intubation and mechanical ventilation until fully awake.
For certain patients, it may be prudent to admit them to an intermediate care or intensive care area postoperatively to facilitate close monitoring and airway support measures. Narcotic analgesics can precipitate or potentiate apnea that may result in a ventilatory arrest. If narcotics are deemed necessary in the postoperative period, appropriate monitoring of oxygenation, ventilation, and cardiac rhythm should be provided. OSA patients at risk for perioperative complications. Safe anesthetic care can be provided by thorough preoperative assessment, a thoughtful and well-executed anesthetic plan, and vigilance which extends well into the postoperative period.