A patient with known obstructive sleep apnoea (OSA) on home CPAP at 10 cmH₂O is scheduled for laparoscopic cholecystectomy. Which perioperative precaution is MOST important?

• A Preoperative overnight polysomnography to re-titrate CPAP settings
• B Mandatory ICU admission postoperatively for all OSA patients regardless of procedure
• C Continuation of CPAP therapy postoperatively; minimise opioids and use regional/multimodal analgesia ✓
• D Preference for ketamine-based TIVA to avoid respiratory depression

Explanation

Patients with OSA are at high risk for postoperative respiratory depression especially in the first 24 hours, compounded by opioids and residual anaesthetics. The STOP-Bang score guides risk stratification. Continuation of habitual CPAP in the recovery room and postoperative ward is the cornerstone of management. Multimodal analgesia (NSAIDs, paracetamol, regional blocks) minimises opioid exposure and respiratory depression risk. Routine ICU for all OSA patients is not recommended; high-risk cases are stratified individually. Routine pre-op polysomnography is unnecessary for established OSA with known CPAP settings.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.