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Chapter 43. Management of a Patient with OSA for Total Thyroidectomy

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Which of the following findings constitute a diagnosis of severe OSA?

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A. STOP-Bang score = 3, AHI <5

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B. Day-time sleepiness and observed apnea by spouse

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C. STOP-Bang score = 5, AHI = 10

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D. STOP-Bang score = 4, AHI = 55

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E. STOP-Bang score = 6, AHI <5

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(D) Diagnosis of OSA is based on history, physical examination, and polysomnography. The STOP-Bang questionnaire has a high sensitivity but a low specificity. Hence there might be cases of “false-positives” whereby the questionnaire identifies a patient to be at high risk of OSA, but the polysomnography demonstrates otherwise.

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Under which circumstance should the surgery be postponed for a referral to a sleep physician for sleep study?

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A. Compliance to PAP therapy

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B. STOP-Bang score = 6, history of atrial fibrillation and room air SpO2 of 92%

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C. Patient refusal for further investigations

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D. STOP-Bang score = 6, presenting for minor extremity surgery

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E. STOP-Bang score = 4, no significant comorbidities

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(B) Factors influencing the decision to postpone surgery for further evaluation include compliance with treatment, type and invasiveness of surgery, and the presence of significant comorbidities. The patient's autonomy needs to be taken into consideration as well.

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Which of the following statements on perioperative management of a patient with suspected/known OSA is false?

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A. Not all patients with OSA require inpatient admission following surgery.

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B. Denitrogenation can be augmented by head-up position and CPAP.

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C. Video-laryngoscopy can be used as Plan A for intubation.

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D. Use of opioids can be reduced with multimodal analgesia.

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E. Anxious patients can be premedicated with oral lorazepam.

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(E) Long-acting sedating premedications can cause excessive sedation and should be avoided to prevent worsening of sleep apnea perioperatively.

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