Postoperative apnea, respiratory strategies, and pathogenesis mechanisms: a review
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REVIEW ARTICLE
Postoperative apnea, respiratory strategies, and pathogenesis mechanisms: a review Alan D. Kaye • McKenzie Mayo Hollon • Nalini Vadivelu • Gopal Kodumudi • Rachel J. Kaye • Franklin Rivera Bueno Amir R. Baluch
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Received: 21 June 2012 / Accepted: 28 October 2012 / Published online: 21 November 2012 Ó Japanese Society of Anesthesiologists 2012
Abstract Recovery from anesthesia is ideally routine and uneventful. After extubation, the recovering postoperative patient ought to breathe without supportive care or additional oxygenation. It has been demonstrated in previous studies that postoperative pulmonary complications are clinically relevant in terms of mortality, morbidity, and length of hospital stay. Compromised postoperative ventilation can be described as the condition in which the postoperative patient does not have satisfactory spontaneous ventilation support and adequate oxygenation. Causes of impaired ventilation, oxygenation, and airway maintenance can be mechanical, hemodynamic, and pharmacologic. This review describes prevalence and differential diagnosis, including co-morbidities of postoperative apnea. A. D. Kaye (&) R. J. Kaye F. R. Bueno Department of Anesthesiology, Louisiana State University School of Medicine, Louisiana State University Health Science Center, 1542 Tulane Ave, Room 656, New Orleans, LA 70112, USA e-mail: [email protected]; [email protected] A. D. Kaye Department of Pharmacology, Louisiana State University Health Science Center, New Orleans, LA 70112, USA M. M. Hollon Department of Anesthesiology, Emory University, Atlanta, GA, USA N. Vadivelu Yale University School of Medicine, New Haven, CT, USA G. Kodumudi School of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, USA A. R. Baluch Metropolitan Anesthesia Consultants, Dallas, TX, USA
The physiological mechanisms of breathing and prolonged postoperative apnea are also reviewed; these mechanisms include influences from the brainstem, the cerebral cortex, and chemoreceptors in the carotid and aortic body. Causes of prolonged postoperative apnea and management are also discussed. Keywords Postop apnea Obesity Medications Brain mechanisms
Introduction Postoperative apnea in the recovery room is a relatively common occurrence. If this condition is not addressed in a timely and appropriate fashion, it can be life-threatening. Prolonged apnea has been defined as the cessation of breathing for more than 20 s. Prolonged apnea has also been defined typically for infants and children as the cessation of breathing for less than 20 s that is accompanied with either bradycardia or oxygen (O2) desaturation [1, 2]. Apnea has also been divided into central apnea, obstructive apnea, and mixed apnea. Central apnea is the absence of nasal or oral airflow and chest wall movement. Obstructive apnea is the lack of nasal or oral airflow in the presence of chest wall movement. Mixed apnea is the combination of central and obstructive apnea [1, 2]. Although it is known that 2 percent of women and 4 percent o
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