Non-invasive respiratory volume monitoring to detect apnea in post-operative patients: case series

Obstructive sleep apnea (OSA) is a potential independent risk factor for postoperative complications, adverse surgical outcomes, and longer hospital stays. Obese patients with OSA have increased post-operative complications. An estimated 25-30% of pre-operative patients are at a high risk for OSA. A novel, non-invasive respiratory volume monitor (RVM) has been developed to provide a real time respiratory curve demonstrating lung volumes as well as a continuous, display of minute ventilation, tidal volume and respiratory rate. Clinical application of this device in the post-anesthesia care unit (PACU) can "unmask" post-operative apneic events resulting from partial or complete airway collapse due to the residual effects of narcotic administration and volatile and/or intravenous anesthetics. Clinical examples from two patients, one with known OSA and one without a previous diagnosis of OSA, monitored in the PACU with RVM are presented here. Post-operatively both patients had an increase in apneic episodes with significant decreases in their MV during apneic episodes after opioid administration as compared to pre-op baseline. In addition, oxygen saturation, for both patients, which is an essential component of current respiratory monitoring remained normal in the cases presented, despite the significant decreases in MV. Continuous RVM monitoring demonstrates both changes in respiratory patterns and overall adequacy of ventilation, and allows practitioners to quantify the increase in the number and duration apneic episodes as a response to narcotic administration. These case studies demonstrate that a non-invasive respiratory volume monitoring system can detect and quantify respiratory disturbances that currently go undetected.