New Guideline for Perioperative Management of OSA

An international expert panel reached consensus on 55 statements and recommendations for a clinical guideline on the perioperative management of obstructive sleep apnea (OSA) in patients receiving metabolic and bariatric surgery.

More than 500,000 cases of metabolic and bariatric surgery are performed each year worldwide, and this number continues to rise. OSA is present in 35% to 94% of these patients. However, consensus regarding the perioperative management of OSA has not yet been established.
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A panel of 15 international experts met in Amsterdam, the Netherlands, and identified 75 questions regarding preoperative screening, treatment, postoperative monitoring, anesthetic care, and follow-up in patients receiving metabolic and bariatric surgery. The literature was systematically reviewed by 6 researchers, and the Amsterdam Delphi Method was used, including controlled acquisition of feedback, aggregation of responses, and iteration.

The panel provided recommendations or statements for 58 of 75 questions. According to the experts, 17 questions provided no additional useful information and could be excluded. The panel reached a consensus of greater than 70% for 55 of 58 provided statements and recommendations.

Ultimately, the panel emphasized that polysomnography is the gold standard for diagnosing OSA and that continuous positive airway pressure is recommended for all patients with moderate to severe OSA. Additionally, OSA patients should be continuously monitored during the early postoperative period with pulse oximetry, and perioperative use of sedatives and opioids should be minimized.

“This first international expert meeting provided 58 statements and recommendations for a clinical consensus guideline regarding the perioperative management of OSA patients undergoing [metabolic and bariatric surgery],” the researchers concluded.

—Christina Vogt

Reference:

de Raaff CAL, Gorter-Stam MAW, de Vries N, et al. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Related Dis. 2017;13(7):1095-1109. doi:10.1016/j.soard.2017.03.022.