Apnées centrales du sommeil primaires et anesthésie: une série de cas rétrospective

Translated title of the contribution: Primary central sleep apnea and anesthesia: a retrospective case series

Alexandru Alexa, Meghna Mansukhani, Bhargavi Gali, Atousa Deljou, Juraj Sprung, Toby N. Weingarten

Research output: Contribution to journalArticle

Abstract

Purpose: Primary (idiopathic) central sleep apnea (PCSA) is a rare central sleep-related breathing disorder characterized by increased chemoreceptor sensitivity to partial pressure of carbon dioxide, which manifests as hyperventilation followed by apnea during non-rapid eye movement sleep. The purpose of this retrospective study was to describe the postoperative course of patients who had PCSA and underwent procedures requiring anesthetic management. Methods: Patients who received a diagnosis of PCSA at our institution and required procedural anesthesia between 1 January 2010 and 1 June 2016 underwent a comprehensive review of their health records with a focus on identifying respiratory complications. Results: Ten patients (nine males, one female) underwent 47 procedures requiring anesthetic management: 20 (43%) under general anesthesia, 25 (53%) with monitored anesthetic care, and two (4%) with regional anesthesia. Procedures were complicated by second-degree heart block in one patient and pneumonia in another two (one had Ivor-Lewis esophagectomy and the other bronchoscopy to evaluate worsening lung infiltration). Hypoxemia (oxyhemoglobin saturation < 90% for three minutes) developed in three patients during anesthesia recovery. One was possibly due to PCSA—a 73-yr-old male with alcoholic cirrhosis who was moderately sedated and hypoxemic after orthopedic surgery; his oxygenation improved with an adaptive servoventilator positive airway pressure device and supplemental oxygen. His underlying medical condition or level of sedation may have contributed to hypoxemia. The other patients became hypoxemic after bronchoscopy. No other cases were complicated by postoperative respiratory compromise. Conclusions: No major adverse outcomes were related to PCSA postoperatively. Nevertheless, continuation of home positive airway pressure therapy during anesthesia recovery was useful in one patient who had cirrhosis and postoperative hypoxemia.

Original languageFrench
Pages (from-to)884-892
Number of pages9
JournalCanadian Journal of Anesthesia
Volume65
Issue number8
DOIs
StatePublished - Aug 1 2018

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Central Sleep Apnea
Anesthesia
Anesthetics
Bronchoscopy
Sleep
Pressure
Alcoholic Liver Cirrhosis
Oxyhemoglobins
Heart Block
Esophagectomy
Hyperventilation
Conduction Anesthesia
Partial Pressure
Apnea
Eye Movements
Carbon Dioxide
General Anesthesia
Orthopedics
Pneumonia
Respiration

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Apnées centrales du sommeil primaires et anesthésie : une série de cas rétrospective. / Alexa, Alexandru; Mansukhani, Meghna; Gali, Bhargavi; Deljou, Atousa; Sprung, Juraj; Weingarten, Toby N.

In: Canadian Journal of Anesthesia, Vol. 65, No. 8, 01.08.2018, p. 884-892.

Research output: Contribution to journalArticle

Alexa, Alexandru ; Mansukhani, Meghna ; Gali, Bhargavi ; Deljou, Atousa ; Sprung, Juraj ; Weingarten, Toby N. / Apnées centrales du sommeil primaires et anesthésie : une série de cas rétrospective. In: Canadian Journal of Anesthesia. 2018 ; Vol. 65, No. 8. pp. 884-892.
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abstract = "Purpose: Primary (idiopathic) central sleep apnea (PCSA) is a rare central sleep-related breathing disorder characterized by increased chemoreceptor sensitivity to partial pressure of carbon dioxide, which manifests as hyperventilation followed by apnea during non-rapid eye movement sleep. The purpose of this retrospective study was to describe the postoperative course of patients who had PCSA and underwent procedures requiring anesthetic management. Methods: Patients who received a diagnosis of PCSA at our institution and required procedural anesthesia between 1 January 2010 and 1 June 2016 underwent a comprehensive review of their health records with a focus on identifying respiratory complications. Results: Ten patients (nine males, one female) underwent 47 procedures requiring anesthetic management: 20 (43{\%}) under general anesthesia, 25 (53{\%}) with monitored anesthetic care, and two (4{\%}) with regional anesthesia. Procedures were complicated by second-degree heart block in one patient and pneumonia in another two (one had Ivor-Lewis esophagectomy and the other bronchoscopy to evaluate worsening lung infiltration). Hypoxemia (oxyhemoglobin saturation < 90{\%} for three minutes) developed in three patients during anesthesia recovery. One was possibly due to PCSA—a 73-yr-old male with alcoholic cirrhosis who was moderately sedated and hypoxemic after orthopedic surgery; his oxygenation improved with an adaptive servoventilator positive airway pressure device and supplemental oxygen. His underlying medical condition or level of sedation may have contributed to hypoxemia. The other patients became hypoxemic after bronchoscopy. No other cases were complicated by postoperative respiratory compromise. Conclusions: No major adverse outcomes were related to PCSA postoperatively. Nevertheless, continuation of home positive airway pressure therapy during anesthesia recovery was useful in one patient who had cirrhosis and postoperative hypoxemia.",
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