Obstrüktif Uyku Apnesi (OSA) Hastalarında Perioperatif Yönetim
Özet
Obstrüktif uyku apnesi (OSA), cerrahi hastalarda ciddi perioperatif riskler oluşturan, üst havayolunun tekrarlayan tıkanıklıklarıyla karakterize bir solunum bozukluğudur. Dünya genelinde artan obezite ve yaşlı nüfus, OSA prevalansını artırırken; birçok hastanın tanı almadan cerrahiye girmesi, pnömoni, atelektezi ve aritmi gibi komplikasyon risklerini yükseltmektedir. Perioperatif yönetim, preoperatif dönemde Berlin veya STOP-BANG gibi anketlerle yüksek riskli hastaların belirlenmesiyle başlar. Tanı konulmuş veya şüpheli vakalarda, havayolu hassasiyeti nedeniyle preoperatif sedasyondan kaçınılmalı ve gerekirse CPAP tedavisine başlanmalıdır. İntraoperatif süreçte, opioidlerin solunum depresan etkilerini sınırlamak için rejyonel anestezi teknikleri tercih edilmeli ve "uyanık ekstübasyon" uygulanmalıdır. Postoperatif dönemde, özellikle 3. ve 5. geceler arasında artan REM uykusu reboundu, hipoksemi riskini zirveye taşır. Bu nedenle, hastaların sürekli pulse oksimetre ile izlenmesi, supin olmayan pozisyonlarda yatırılması ve ağrı yönetiminde opioid dışı ajanların kullanılması kritiktir. Özellikle pediyatrik ve obez hastalarda yakın takip, yaşam kalitesini artırmak ve malpraktis risklerini azaltmak için elzemdir.
Obstructive sleep apnea (OSA) is a respiratory disorder characterized by recurrent upper airway obstructions that pose significant perioperative risks for surgical patients. While increasing obesity and aging populations globally raise OSA prevalence, many patients undergo surgery undiagnosed, increasing the risk of complications such as pneumonia, atelectasis, and arrhythmia. Perioperative management begins with identifying high-risk patients in the preoperative period using screening tools like the Berlin or STOP-BANG questionnaires. In diagnosed or suspected cases, preoperative sedation should be avoided due to airway sensitivity, and CPAP therapy should be initiated if necessary. During the intraoperative phase, regional anesthesia techniques are preferred to limit the respiratory depressant effects of opioids, and "awake extubation" must be performed. In the postoperative period, REM sleep rebound—particularly between the 3rd and 5th nights—elevates the risk of hypoxemia to its peak. Therefore, continuous pulse oximetry monitoring, maintaining non-supine positions, and utilizing non-opioid agents for pain management are critical. Close monitoring, especially in pediatric and obese patients, is essential to improve quality of life and mitigate malpractice risks.
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