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Anesth Analg. 2018 Oct;127(4):967-987. doi: 10.1213/ANE.0000000000003434.

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea.

Author information

1
From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.
2
Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
3
Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph's Health Care, Western University, London, Ontario, Canada.
4
Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
5
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas.
6
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Palo Alto, California.
7
Department of Anesthesiology, Northwestern University, Chicago, Illinois.
8
Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
9
Department of Anesthesia, Critical Care, and Pain Management, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
10
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
11
Toronto Sleep and Pulmonary Centre, Toronto, Canada.
12
Department of Anesthesia and Pain Management, Women's College Hospital, Toronto, Canada.
13
Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
14
Department of Anesthesiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Abstract

The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.

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