Occlusive Sleep Apnea (OSA) Screening and Preemptive Continuous Positive Airway Pressure (CPAP)/Bilevel Positive Airway Pressure (BiPAP) Application Is Effective in Reducing Post Bariatric Surgery Pulmonary Complications

Abstract

PURPOSE: To examine the effectiveness of American Society of Anesthesiology (ASA) protocol in minimizing post-bariatric surgery pulmonary complications. METHODS: Setting: 45 bed university community hospital and a high volume Bariatric surgery center in northern Brooklyn, NY. Patients and Methods: All patients with bariatric surgery between //9 and 8/3/ were included. The ASA peri-operative anesthesia protocol was followed: All were screened for OSA with STOP-BANG questionnaire. Patients at high risk for OSA had nocturnal Polysomnography (PSG) with CPAP/BiPAP titration. Patients were encouraged to comply with prescribed home nocturnal CPAP/ BiPAP pre operatively. Patients with BMI 35-42 had gastric banding only. They were discharged home the same day after a short period of observation in the recovery room. Patients who had gastric bypass surgery were monitored for cardiopulmonary complications for 24 hrs in recovery room and an additional 24 hrs in surgical ward. All Patients with OSA/OHS were prophylactically placed on CPAP/BiPAP respectively during postoperative period. Pain was controlled with regional anesthetic agents and opiates were used sparingly. RESULTS: Results: Table : Demographics, OSA and Bariatric surgeries Patient characteristics Patients (%) Male/Female 34(3)/222(87) BMI intervals 35-39/4-49/5-59/>6 54/25/53/3 Smokers/non-smokers 67(32)/53(68) Co-morbidities: Hypertension/Asthma 9/6 Heart failure/ Diabetes mellitus /7 Laparoscopic Surgeries: Gastric banding/Bypass 64(26)/86(74) PSG: Normal/OSA/ Not done 5/49/56 OSA: Mild/Moderate/Severe 54(36)/4/(27)/55(37) Table-2:Cardio-pulmonary complications Complications Prevalence( %) Total 2(4.6) Atelectasis 7 Pneumonia Respiratory failure Pulmonary embolism Heart failure 2 CONCLUSIONS: Strict adherence to ASA bariatric surgery protocol resulted in low post-bariatric surgery cardio-pulmonary complications in patients with OSA. The risk reduction strategies were screening with STOP-BANG questionnaire, PSG with CPAP titration, 24 hr. cardiopulmonary monitoring and pre emptive application of CPAP/BiPAP in patients with OSA and OHS.