Obstructive sleep apnoea (OSA) diagnosed preoperatively requires specific anaesthetic considerations. Which postoperative monitoring strategy is most appropriate for a patient with severe OSA undergoing major abdominal surgery?
- A Routine ward monitoring with 2-hourly nursing observations for 12 hours
- B Prophylactic postoperative ventilation in ICU for 48 hours in all severe OSA cases
- C Continuous pulse oximetry monitoring in a monitored setting and use of patient's own CPAP device post-extubation ✓
- D Avoidance of all opioid analgesia replaced by NSAIDs alone
Correct answer: C. Continuous pulse oximetry monitoring in a monitored setting and use of patient's own CPAP device post-extubation
Explanation
Severe OSA patients are at high risk for postoperative respiratory complications due to upper airway collapsibility, hypercapnia, opioid sensitivity, and residual anaesthetic effects. Current evidence-based recommendations include continuous pulse oximetry monitoring in a step-down or monitored unit, use of their prescribed CPAP/BiPAP device as soon as safely tolerated post-extubation, and multimodal analgesia to minimise opioid exposure. Opioid-sparing (not complete avoidance) is recommended; NSAIDs alone would be inadequate for major surgery.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.