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BioScience II > Test #2 OSA PPt- Josh > Flashcards

Test #2 OSA PPt- Josh Flashcards

1
Q

OSA: definition

OSA is the cessation of airflow for more than ____ seconds dispite continuing ventilation effort, ____ or more times per ____ of sleep, and is usually associated w/ a decrease in arterial O2 saturation SAO2 or more than ___%

A
  • 10 sec
  • 5 or more
  • per hour
  • 4%
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2
Q

OSA:

what % of general sx pts have OSA:

A

25%

(just thought that is alot)

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3
Q

OSA:

what are conditions that cause OSA

A
  • Obesity
  • Race/genetics
  • Age
  • Male
  • Alcohol/sedatives/analgesics/anesthestics
  • Smoking
  • Nasal/pharyngeal/laryngeal obstruction
  • Cranio-facial abnormality
  • endocrine/metabolic d/o
  • Connective tissue d/o
  • Storage diseases
  • Chronic renal failure
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4
Q

OSA:

what are the 3 main muscles of the upper airway that are considered dilator muscles? (they are the ones that keep the airway open)

A

from top to bottom airway

tensor palatine

Genio glossus

Hyoid Muscles

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5
Q

OSA:

what is the circular cycle of OSA

10 steps

A
  • Sleep
  • decreased airway tone
  • Obstruction
  • Apnea
  • decreased PO2 increased PCO2
  • Sympathetic Surge
  • Arousal
  • Increased airway tone
  • Breathing resumes
  • back to sleep and cycle restarts
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6
Q

OSA: Patho

with OSA the obstructed breathing can cause decreased O2 and Increased CO2 wchich can leax to what complications

A
  • Arrhythmias- MI
  • Pulmonary HTN- RVH
  • Systemic HTN- LVH
  • Daytime sleepiness-personality/behavior changes- accident prone
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7
Q

OSA: classification

what are the 3 classifications?

A
  • Mild
  • moderate
  • Severe
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8
Q

OSA: classification

what is the AHI (apnea/hypopnea index) for mild OSA

A
  • 5-15 episodes/ hr
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9
Q

OSA: classification

what are clinical findings with mild OSA

A
  • Mild sleepiness/insomnia
  • Mild O2 desat
  • Benign cadiac arrhythmia
    *
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10
Q

OSA: classification

what is the AHI for moderate OSA

A
  • 15-30 episodes/hr
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11
Q

OSA: classification

S/S of moderate OSA

A
  • Moderate daytime sleepiness, fatigue that interferes w/ ADLs
  • Moderte O2 desat
  • Mild arrhythmias
  • At risk for injuries/accidents
  • At risk for HTN/MI/Stroke/Cor pulmonale
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12
Q

OSA: classification

what is severe OSA AHI

A
  • > 30 episodes/hr
  • and/or
  • Hypoxia < 90% for >20% of total sleep time
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13
Q

OSA: classification

S/S of severe OSA

A
  • daytime sleepiness interferes w/ normal activities
  • Severe O2 desat
  • Moderate to severe cardiac arrhythmia
  • At increased risk for injuries/accidents
  • At risk for HTN, MI, Stroke, and cor pulmonale
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14
Q

Screening for OSA:

what is the gold standard for screening?

A
  • Polysomnography
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15
Q

Screening for OSA:

what is the con of the polysomnography

A
  • Not practical for each surgical pt
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16
Q

Screening for OSA:

what screening tool is good for primary care?

A
  • Berlin Questionnaire
  • (usefullness w/ surgical pt’s has not been established)
17
Q

Screening for OSA:

what is overall the most practical screening tool?

A

STOP-BANG questionaire

18
Q

Screening for OSA:

what all does the Polysomnography test, test for?

A
  • Brain activity for sleep
  • eye movement
  • Air movement
  • Muscle tone (pharynx neck)
  • heart action
  • Chest movement
  • Abd movement
  • O2 saturation
  • Leg movement
19
Q

Screening for OSA:

the berlin questionaire is 3 categories and 10 questions,

1 positive score for OSA is what?

A
  • 2 points or more in cat 1
  • 2 or > points in cat 2
  • if #10 is yes and BMI > 30 in cat 3
20
Q

Screening for OSA:

w/ the berlin you have a high risk for OSA if what?

And a low risk for OSA if what?

A
  • 2 or more cat pos (high risk)
  • only 1 cat or no cat pos
21
Q

Screening for OSA: STOP-BANG

tell me all the questions

A
  • S- Do you SNORE loudly (louder than talking or can be heard through a closed dorr)
  • T- do you often feel TIRED, fatigued, or sleepy during the daytime?
  • O- has anyone OBSERVED you stop breathing during your sleep?
  • P- do you have or are you being treated for high blood PRESSURE?
  • B- BMI > 35kg/m2
  • A- AGE > 50
  • N- NECK circumference > 40 cm?
  • G- GENDER male

stop is subjective-do you/ have you/ has anyone?

Bang- is objective- things we see!

22
Q

Screening for OSA:

w/ STOP-BANG

what scores show a high risk?

what scores show a low risk?

A
  • high risk- yes to > 3 items
  • Low risk- yes to < 3 items

like rudy said tough b/cas men we are starting w/ 2 points we are always tired and male, and DWAYNE is over 50 so he basically has OSA automatically (sorry to bare the bad news)

23
Q

OSA: treatment

what is teh treatment?

A
  • CPAP
  • Oral appliances
  • Behavioral modification
  • Surgical intervention
24
Q

OSA:

what is central Sleep Apnea (CSA)

A
  • cessation of airflow w/o respiratory effort
25
Q

OSA: CSA

when does CSA occur?

A
  • when PCO2 falls below apneic threshold
26
Q

OSA:

CSA makes up what % of all sleep anpea cases

A
  • 20%
27
Q

CSA:

what are the 3 types

A
  • Cheyne-stokes breathing
  • Idiopathic central apnea
  • Narcotic induced central apnea
28
Q

CSA:

what is the etiology of CSA?

A
  • NM d/o
  • Excessive resp load (obesity)
  • D/O of central ventilatory control (CVA)
  • Endocrine/metabolic
29
Q

CSA:

treatment

A
  • Optimize medical therapy
  • CPAP
  • Oxygen
  • Inhaled Co2
  • Acetazolamide
  • Theophylline
30
Q

OSA: Anesthestic implications:

pwhat should you do preop?

A
  • STOP-BANG
  • talk to family members
  • If they use CPAP bring machine for post-op
  • Regional vs GETA
  • Airway assessment
31
Q

OSA: Anesthestic implications:

intraop

A
  • Anticipate difficult airway
  • GETA vs deep sedation
  • Spinal or Epidural for LE procedures
  • Concientious Anesthestic choices
  • Adjuncts for pain control
  • NMBD fully reversed
32
Q

OSA: Anesthestic implications:

Extubation

A

Fully awake

Semi-upright position

Airway exchanger catheter

33
Q

OSA: Anesthestic implications:

Postop what to consider

A
  • Consider status of OSA (treated vs Untreated)
  • Anotommical abnormalities
  • Levels of co-morbidities
  • type of sx
  • Anesthesia modality
  • Postop opioid use
34
Q

Thats it

A

Thanks RTFF

BioScience II (39 decks)

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