We can diognose OSA

[caligas]

Persistent snoring under conscious sedation during colonoscopy is a predictor of obstructive sleep apnea. - PubMed - NCBI

Not exactly shocking, I guess

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[jeesapeesa]

so basically everybody

 

[dhb]

so basically everybody

Not so much the snores as the pauses. Some patients are just a live OSA show

 

[Twiggidy]

Not so much the snores as the pauses. Some patients are just a live OSA show

yeah. i heard a real deal OSA a few weeks ago. the patient was snoring under sedation and then suddenly there was dead silence (chest wall still moving) and then suddenly another snore almost a minute later

i wouldn't say we "overdiagnose" sleep apnea in medicine but definitely anyone who snores we tend to call them sleep apnea when in reality they just snore

 

[narcusprince]

We can cure it too with a well oiled lubricated nasal trumpet.

 

[deleted162650]

We can cure it too with a well oiled lubricated nasal trumpet.

Yup. Screw CPAP. If I ever develop OSA, some hurricane spray and a nasal trumpet will go home with me every night.

 

[caligas]

Yup. Screw CPAP. If I ever develop OSA, some hurricane spray and a nasal trumpet will go home with me every night.

“Anesthesiologist dies in home from methemoglobinemia”

 

[deleted162650]

“Anesthesiologist dies in home from methemoglobinemia”

No, I'm gonna chase it with a little methylene blue.

 

[narcusprince]

“Anesthesiologist dies in home from methemoglobinemia”

Over rated from benzocaine spray. I use the heck out of that stuff for TEEs and egds in sick players. And I like the bottle not the single jets. If they can tolerate a tongue depressor they are good.

 

[zizzer]

This doesn't seem like it's diagnosing OSA as much as identifying high-risk patients for testing. That's like saying I could diagnose them from a stop-bang score.

 

[cchoukal]

Over rated from benzocaine spray. I use the heck out of that stuff for TEEs and egds in sick players. And I like the bottle not the single jets. If they can tolerate a tongue depressor they are good.

I have definitely caused two cases of this with benzocaine (paste, not even the spray). Highest level was 28%. It absolutely happens.

 

[narcusprince]

I have never used the paste only the spray. I am interested in knowing your management after the diagnosis? Please share. Why the paste?

 

[deleted59964]

Persistent snoring under conscious sedation during colonoscopy is a predictor of obstructive sleep apnea. - PubMed - NCBI

Not exactly shocking, I guess

pfft – the last OSA patient I diagnosed was snoring in the preop area. the guy fell asleep during my consent discussion. I then stuck a pulse oximeter on his finger and found that during his apneas his sats hit 82% ... now that's OSA

 

[narcusprince]

We have all these criterion and scoring of patients for osa. None of this stiff changes management except in the pediatric population. What we have created is more boxes to check for the lawyers. If i see an obese, male, mp 4, who looks sleepy during the preop. I will be very conservative with my anesthetic. Slow propofol titration, possible simple mask, nasal trumpet close by. Oxygen 4-6l. I dont need a stop bang or really anything for further management of osa.

 

[cchoukal]

I have never used the paste only the spray. I am interested in knowing your management after the diagnosis? Please share. Why the paste?

I used the paste because it’s what we stocked. I was taught in residency that the reason the spray can cause methemoglobinemia was because patients would inadvertently inhale the medication while we were spraying in their throat, and that the inhalation promoted a greater degree of systemic absorption. I thought using the paste was safer.

The procedure was opera Naskapi, and the patient tolerated the procedure fine until close to the end where the saturation settled around 88, Despite seemingly adequate respiration. I rushed to the gastroenterologist to finish, and brought the patient to recovery where he remained asymptomatic, but with a low saturation. A blood gas showed a high PO 2. Our hospital has a cyanosis panel that includes co-oximetry and tests for other hemoglobin species. The Methemoglobin level came back elevated, and I treated with methylene blue (I don’t recall the dose; I probably looked it up).

He improved very quickly, and wanted to go home. His level was so high that I wanted to admit him, but he refused, stating he had to take care of his dog. A lot of our patients don’t have other social resources to help with things like this. Fortunately, our system is well-connected, I could see that he appeared for his methadone clinic visit the next morning, so all is well.

 

[pgg]

None of this stiff changes management except in the pediatric population.

[...]

If i see an obese, male, mp 4, who looks sleepy during the preop. I will be very conservative with my anesthetic. Slow propofol titration, possible simple mask, nasal trumpet close by. Oxygen 4-6l.

Sounds like you change your management for adult OSA'ers.

 

[deleted59964]

We have all these criterion and scoring of patients for osa. None of this stiff changes management except in the pediatric population. What we have created is more boxes to check for the lawyers. If i see an obese, male, mp 4, who looks sleepy during the preop. I will be very conservative with my anesthetic. Slow propofol titration, possible simple mask, nasal trumpet close by. Oxygen 4-6l. I dont need a stop bang or really anything for further management of osa.

really?
i push for neuraxial a bit harder if its an option, am more likely to do a block for post op analgesia, and more likely to prescribe a pca

 

[anbuitachi]

I feel like over here, most of the colonoscopies with propofol are done under deep sedation, sometimes general anesthesia. cause those patients are not giving purposeful responses with painful stimulus.

 

[narcusprince]

Sounds like you change your management for adult OSA'ers.

I am saying I dont need to formally diagnose someone as having osa to enact the opioid sparing regionalish technique. If i see an obese mp4 who snores I treat him as such. The condition of osa has become a medicolegal diagnosis forget to put it in the chart or dont have a policy to screen you get dinged by jc. I still place it in the chart but It does not change anything.

 

[deleted59964]

I am saying I dont need to formally diagnose someone as having osa to enact the opioid sparing regionalish technique. If i see an obese mp4 who snores I treat him as such. The condition of osa has become a medicolegal diagnosis forget to put it in the chart or dont have a policy to screen you get dinged by jc. I still place it in the chart but It does not change anything.

ah ok - i misunderstood what you were getting at

 

[fakin' the funk]

...benzocaine spray. I use the heck out of that stuff for TEEs and egds in sick players. And I like the bottle not the single jets. If they can tolerate a tongue depressor they are good.

Topical anesthesia (agent of your choice) and WAYYY less sedative requirements in this patient population is very underrated and underutilized IMO. Viscous lido or some atomized lido are very nice too.

 

[drmwvr]

Had an episode from Americaine spray for FOB lubrication for DLT placement. Sprayed the scope and both lumens of the tube. It's a crappy way to lubricate the scope that had become institutionalized where I was. Scoff if you want...it happened. I use silicone spray now.

And how hard is it to at least suspect if not diagnose OSA just by taking a good history? I'd like to see a study comparing a sleep study and H and P. Observation is actually a thing, after all...eye balling EF on echo is as accurate as a formal measurement...

And for those not in the know...don't put a nasal airway in someone on coumadin or a DTI/Xa inhibitor...

 

[drmwvr]

Viscous lido or some atomized lido are very nice too.