RESUMO
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing characterized by periods of partial or complete obstruction of the upper airway during sleep, resulting in oxygen desaturations. Symptoms and risk factors for OSA are of particular importance in the management of OSA patients in the perioperative setting. The present study collected data regarding the intraoperative airway management of OSA patients and their course in the postanesthesia care unit (PACU) over a six-month period. A total of 86 patients underwent general anesthesia, 63 of whom were intubated by direct laryngoscopy. Of these, 43% were classified as a grade 1 view by direct laryngoscopy, 43% were grade 2 and 14% were classified as grade 3. Apnea events or periods of desaturation in the PACU were observed in 27% of cases. Length of stay was significantly longer for cases in which PACU nurses had indicated that OSA had affected the individuals' postoperative course of treatment. Overall, OSA patients had an increased frequency of grade 3 views compared with the general population, and adjuncts were commonly used to help secure the airway in OSA patients. Symptomatic OSA patients placed increased demands on the PACU in terms of length of stay and hospital resources.
L'apnée obstructive du sommeil (AOS) est une forme de trouble respiratoire du sommeil caractérisée par des périodes d'obstruction partielle ou complète des voies respiratoires supérieures pendant le sommeil, qui provoque des désaturations en oxygène. Les symptômes et facteurs de risque d'AOS revêtent une importance particulière pour la prise en charge des patients atteints d'AOS en milieu périopératoire. La présente étude a permis de colliger, sur une période de six mois, des données sur la prise en charge intraopératoire et l'évolution des voies supérieures des patients atteints d'AOS à l'unité de soins posthanesthésique (USPA). Au total, 86 patients ont subi une anesthésie générale. De ce nombre, 63 ont été intubés par laryngoscopie directe, dont 43 % ont obtenu une vue de classe 1, 43 %, une vue de classe 2 et 14 %, une vue de classe 3. Dans 27 % des cas, les chercheurs ont observé des épisodes d'apnée ou de désaturation à l'USPA. La durée d'hospitalisation était beau-coup plus longue dans les cas où, selon les infirmières de l'USPA, l'AOS avait nui à l'évolution postopératoire du traitement. Dans l'ensemble, les patients atteints d'AOS présentaient davantage de vues de classe 3 que la population générale, et il fallait souvent utiliser des accessoires pour sécuriser leurs voies respiratoires. À l'USPA, les patients symptomatiques atteints d'AOS étaient hospitalisés plus longtemps et mobilisaient plus de ressources hospitalières.
RESUMO
Optimal visualization of the glottis can be crucial to successful laryngoscopy. Limited information has been published on the light intensity delivered from laryngoscopes powered by rechargeable batteries. In this study the laryngoscope light intensity delivered from 10 nickel metal hydride (NiMH), 7 nickel cadmium (NiCAD), and 2 lithium (LI) batteries with 3-5 or more years of clinical usage were tested in comparison to 5 new NiMH batteries. Each battery was charged in a new laryngoscope handle and recharging unit for 24 h before testing. Light intensity (lux) from the bulb in the laryngoscope handle was recorded at 3-min intervals under continuous loading until battery depletion. The mean times ±1 standard deviation (SD) to minimum acceptable light output (2,000 lux from the handle) were new NiMH 70 ± 1 min, 3-year-old NiMH 96 ± 2 min, 5+ year-old NiCAD 45 ± 22 min, and 5+ year-old LI 117 ± 4 min. There were significant differences in the time to minimum light intensity among all groups (p = 0.00-0.04). All new and used batteries exceeded the minimum ISO standard of light intensity for more than 10 min. These data demonstrate that rechargeable laryngoscope batteries can safely be used for several years before requiring replacement.
