[sunnymqt]

Does any one have protocol orders or a care plan for patients that are at risk for obstructive sleep apnea in the outpatient procedure areas or post anesthesia?

[PageRespiratory!]

Originally Posted by sunnymqt

Does any one have protocol orders or a care plan for patients that are at risk for obstructive sleep apnea in the outpatient procedure areas or post anesthesia?

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I used to work in a large hospital that did a lot of bariatric surgery. Most of the time the surgeon would write for the Pt. to bring thier own CPAP from home, if they didn't have a home machine, they'd leave orders.

[sleepapnea_ed]

There is useful information on sleep apnea patients in the hospital setting on the ASAA web site http://sleepapnea.org/info/practitioner/anespain.html

The ASAA has released a new patient education video which will have its premiere during National Sleep Awareness Week - which starts tomorrow.

[RN Randy]

Well... if "at risk" is the actual intent, then most of it would be plain ol' assessment and treatment. Raise HOB, use pillows behind shoulders/head being sure the point is an increased angle of the neck/spine at waist, and not flexion of the neck. [chin on chest], monitor analgesic/narcotic use as it will have a much higher effect on the aw musculature and breathing, etc.
Position on side, use supplemental O2 and such, and if they say they do better in a recliner, put them in one.

If you mean how to handle pts with a confirmed Dx of OSAS and already on home CPAP, then you'll need to ask the pt or their sleep doc what settings they are on, what type of mask they use and so on if you plan to use CPAP/BiPAP yourself.
Usually a nice loud snore or hypopneas with a good sat is no problem as we are working with only a short period of time during recovery, and missing home CPAP for 3-5 hours won't be an issue if there are no horrible sat problems.

Apneas of any kind with anesthesia or narcs onboard would make me worry a little and want the mask on, ours or theirs, and simply write titrate pressure to minimize snoring and keep sat >88-90%, use backup rate for RR <10, or whatever is normal in your facility for NIV. RT should know what to do with little prompting.
rb