• Sebastian Zaremba, Christina H Shin, Matthew M Hutter, Sanjana A Malviya, Stephanie D Grabitz, Teresa MacDonald, Daniel Diaz-Gil, Satya Krishna Ramachandran, Dean Hess, Atul Malhotra, and Matthias Eikermann.
• From the Department of Anesthesia, Critical Care and Pain Medicine (S.Z., C.H.S., S.A.M., S.D.G., T.M., D.D-.G., M.E.), Department of Surgery (M.M.H.), and Respiratory Care, Department of Anesthesia, Critical Care and Pain Medicine (D.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Sleep Medicine, Department of Neurology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany (S.Z.); German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Bonn, Germany (S.Z.); Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan (S.K.R.); Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Diego, La Jolla, California (A.M.); and Department of Anesthesia and Critical Care, University Hospital Essen, Essen, Germany (M.E.).
• Anesthesiology. 2016 Jul 1; 125 (1): 92-104.

BackgroundBariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression.MethodsIn a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O). During 1 h of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea after self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing.ResultsSixty-four percent of the 33 patients with complete postoperative polysomnography data demonstrated SDB (AHI greater than 5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8 ± 2/h vs. 25 ± 5/h, P < 0.001), decreased oxygen desaturations (5 ± 10/h vs. 16 ± 20/h, P < 0.001), and increased the mean oxygen saturation by 3% (P = 0.003). CPAP significantly decreased the respiratory-depressant effects observed during wakefulness-sleep transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (P < 0.001), inspiratory flow (P = 0.002), and minute ventilation (P = 0.015) were significant.ConclusionsThis pharmacophysiologic interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory-depressant effects of opioids without undue hemodynamic effects.

31 keywords...

hide…