Airway management in obstructive sleep apnea: local solutions.

摘要

After reading the Continuing Professional Development Module on the management of sleep apnea, I suggest two additional airway management strategies to minimize short-term adverse outcomes in selected intubated patients with obstructive sleep apnea (OSA). First, to reduce the incidence of airway irritation with its attendant coughing and breath holding, I use lidocaine gel on the external cuff of the endotracheal tube as well as intracuff lidocaine (2% preservative free lidocaine 3 mL, no alkalinization). The patient is placed in a semi-upright position and, despite being under a light plane of anesthesia, tolerates the endotracheal tube. The use of local anesthetics prevents, or at least attenuates, troublesome airway reflexes that compromise functional residual capacity (cough, breath holding) or airway patency (laryngospasm). The emerging patient's tidal volumes can be kept well above closing capacity without disruptive emergence airway reflexes by employing a ventilator pressure support mode or hand-bag assisted ventilation until the patient is "fully conscious".