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  • Clinical Indicators of the Need for Telemetry Postoperative Monitoring in Patients With Suspected Obstructive Sleep Apnea Undergoing Total Knee Arthroplasty

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Regional anesthesia and acute pain: Original articles
Clinical Indicators of the Need for Telemetry Postoperative Monitoring in Patients With Suspected Obstructive Sleep Apnea Undergoing Total Knee Arthroplasty
  1. Kethy M. Jules-Elysée, MD*,
  2. Natasha A. Desai, BA*,
  3. Yan Ma, PhD†,
  4. Wei Zhang, PhD†,
  5. Thuyvan H. Luu, BS*,
  6. Stavros G. Memtsoudis, MD, PhD* and
  7. Gregory A. Liguori, MD*
  1. *Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
  2. †Department of Epidemiology and Biostatistics, George Washington University, Washington, DC
  1. Address correspondence to: Kethy M. Jules-Elysée, MD, Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (e-mail: JulesElyseeK{at}HSS.EDU).

Abstract

Background and Objectives Obstructive sleep apnea is associated with increased complication rates postoperatively. Current literature does not provide adequate guidance on management of these patients. This study used the STOP-Bang questionnaire to diagnose patients with possible obstructive sleep apnea (score ≥3). We hypothesized that a STOP-Bang score of 3 or greater would significantly correlate with the number of oxygen desaturation episodes during the first 48 hours after total knee arthroscopy.

Methods The STOP-Bang questionnaire was administered to 110 patients preoperatively. All patients underwent spinal-epidural anesthesia with a saphenous nerve block and sedation and were connected to the Nellcor OxiMax N-600x pulse oximeter for 48 hours postoperatively.

Results Final analysis included 98 patients. There was no significant difference in the total number of desaturation events between STOP-Bang groups (score <3 vs ≥3 and score <5 vs ≥5). The total number of desaturation events on postoperative day 1 was greater than that on day 0 (32.8 ± 42.7 vs 4.1 ± 10.0, P < 0.0001). The total number of desaturation events correlated with length of hospital stay (r = 0.329, P = 0.0001). Patients with a preoperative serum CO2 of 30 mmol/L or greater had significantly longer episodes of desaturation on postoperative day 0 compared with CO2 of less than 30 mmol/L (233.7 ± 410.1 vs 82.0 ± 126.2 seconds, P = 0.044).

Conclusions A high preoperative value of CO2 should be a warning for possible prolonged episodes of desaturation postoperatively. An attempt to limit postoperative desaturation events should be made to minimize length of stay.

https://doi.org/10.1097/AAP.0000000000000666

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    Footnotes

    • This work is attributed to the Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.

      This study was funded by Hospital for Special Surgery's Anesthesiology Department Research and Education Fund, New York, NY. The REDCap electronic data capture tools are funded by the Clinical and Translational Science Center grant (grant UL1 TR000457-06) from the National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD.

      This work was presented in part at the 41st Annual Regional Anesthesiology and Acute Pain Medicine Meeting (New Orleans, LA), March 31 to April 2, 2016.

      S.G.M. has received compensation for consultation from HappyMed (Vienna, Austria). The other authors declare no conflict of interest.