Test #2 OSA PPt- Josh Flashcards Preview

Bioscience II Brandon > Test #2 OSA PPt- Josh > Flashcards

Flashcards in Test #2 OSA PPt- Josh Deck (34):
1

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 ___%

 

  • 10 sec
  • 5 or more
  • per hour
  • 4%

 

 

2

 

OSA:

what % of general sx pts have OSA:

25%

(just thought that is alot)

3

OSA:

what are conditions that cause OSA

  • 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

4

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)


from top to bottom airway

tensor palatine

Genio glossus

Hyoid Muscles

5

OSA:

what is the circular cycle of OSA

10 steps

 

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

 

6

OSA: Patho

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

 

 

 

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

 

7

OSA: classification

what are the 3 classifications?

  • Mild
  • moderate
  • Severe

8

OSA: classification

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

  • 5-15 episodes/ hr

9

OSA: classification

what are clinical findings with mild OSA

  • Mild sleepiness/insomnia
  • Mild O2 desat
  • Benign cadiac arrhythmia

10

OSA: classification

what is the AHI for moderate OSA

  • 15-30 episodes/hr

11

OSA: classification

S/S of moderate OSA

  • 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

12

OSA: classification

what is severe OSA AHI

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

13

OSA: classification

S/S of severe OSA

  • 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

14

Screening for OSA:

what is the gold standard for screening?

  • Polysomnography

15

Screening for OSA:

what is the con of the polysomnography

  • Not practical for each surgical pt

16

Screening for OSA:

what screening tool is good for primary care?

  • Berlin Questionnaire
  • (usefullness w/ surgical pt's has not been established)

17

Screening for OSA:

what is overall the most practical screening tool?

STOP-BANG questionaire

18

Screening for OSA:

what all does the Polysomnography test, test for?

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

19

Screening for OSA:

the berlin questionaire is 3 categories and 10 questions,

1 positive score for OSA is  what?

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

20

Screening for OSA:

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

And a low risk for OSA if what?

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

21

Screening for OSA: STOP-BANG

tell me all the questions

  • 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

Screening for OSA:

w/ STOP-BANG

what scores show a high risk?

what scores show a low risk?

  • 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

OSA: treatment

what is teh treatment?

  • CPAP
  • Oral appliances
  • Behavioral modification
  • Surgical intervention

24

OSA:

what is central Sleep Apnea (CSA)

  • cessation of airflow w/o respiratory effort

25

OSA: CSA

when does CSA occur?

  • when PCO2 falls below apneic threshold

26

OSA:

CSA makes up what % of all sleep anpea cases

  • 20%

27

CSA:

what are the 3 types

 

  • Cheyne-stokes breathing
  • Idiopathic central apnea
  • Narcotic induced central apnea

28

CSA:

what is the etiology of CSA?

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

29

CSA:

treatment

  • Optimize medical therapy
  • CPAP
  • Oxygen
  • Inhaled Co2
  • Acetazolamide
  • Theophylline

30

OSA: Anesthestic implications:

pwhat should you do preop?

 

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

31

OSA: Anesthestic implications:

intraop

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

32

OSA: Anesthestic implications:

Extubation

Fully awake

Semi-upright position

Airway exchanger catheter

33

OSA: Anesthestic implications:

Postop what to consider

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

34

 

Thats it

Thanks RTFF