**6.1 Introduction**

OSA is considered one of the important challenges in the peri-operative airway management. Obstructive apneas are defined as complete or near-complete cessation of airflow lasting for at least 10 sec. Obstructive hypopneas are characterized by at least 30% reduction in airflow for a minimum of 10 sec and are associated with a 4% oxygen desaturation [18].

The difficult airway in OSA patients is considered to be a main contributing factor to the higher rate of adverse respiratory and cardiovascular events, so to reduce the peri-operative complication [19], it is better to divide the management approach of OSA patients into: preoperative, intraoperative, and postoperative strategies.

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*Airway Management in Head and Neck Pathology DOI: http://dx.doi.org/10.5772/intechopen.94498*

ing comorbidities.

can be taken [20].

**6.2 Pre-operative assessment in suspected OSA patients**

• A detailed history includes: loud snoring, observed apnea, daytime sleepiness, and morning headaches, with emphasis on airway examination and identify-

• OSA screening and diagnosis (results of screening tools/questionnaires such as those with STOP-BANG scores ≥5 with co-morbidities, full attended polysomnography (PSG) should be done prior to any major elective surgery and reviewed by sleep physician, while the other suspected OSA patients without co-morbidities and undergoing minor surgery, appropriate risk reduction steps

• All patients after diagnosis of OSA has been established who use CPAP preoperatively (compliant and noncompliant) should be advised to bring the device to the hospital for use in the postoperative period, so that it is readily applicable

During anesthesia; alteration of muscle activity results in upper airway collapse more at the level of retro-lingual. Such obstructive events require active intervention to arouse spontaneously, which is an important defense mechanism that occurs

The administration of anesthetic agents exacerbates the upper airway collapse, alter the tone of the pharyngeal musculature, result in delay of the restoration of airway patency, therefore, in general the tendency for airway obstruction occurs out

Patients with OSA undergoing upper airway surgery are at high risk for difficult airway management and increased incidence of postoperative complications. These complications include higher re-intubation rates, hypercapnia, oxygen desaturations, cardiac arrhythmias, myocardial injury, delirium, unplanned ICU transfers,

*Several perioperative and anesthetic factors may contribute to these complications* [22]:

2.The *patient's position* during anesthesia can negatively affect the traction forces in the trachea, leading to increased pharyngeal closing pressure and collapse of

3.Prolonged intubation may lead to pharyngeal edema and narrowing of the

4.Decreased airway stability caused by prolonged postoperative patient's supine

1.*Medication*: drugs commonly used during general anesthesia (hypnotics,

• Physical examination: characteristics predicting a difficult airway (highly

modified Mallampati score, reduced thyromental distance) [19].

whenever under the influence of narcotics or sedatives [21].

during natural sleep to overcome airway obstruction.

of proportion to the level of achieved sedation [22].

**6.4 Post-operative assessment**

and longer hospitalization stays.

the upper airway.

upper airway.

position.

opioids and muscle relaxants).

**6.3 Intra-operative assessment and impact of anesthesia on OSA patients**

*Special Considerations in Human Airway Management*

postoperative period [11, 12].

if not managed in proper time.

agreed by the multidisciplinary team.

tively is highly important.

traumatic.

**6.1 Introduction**

with a 4% oxygen desaturation [18].

**5.6 Key points**

management includes good communication between all of the multidisciplinary team, handover to be written and verbal with clear description of the problem and how it was managed, the current state of the airway, what is the ongoing plane of

• Airway management continues from pre and peri-operative period to the

• Postoperative airway obstruction usually leads to high incidence of morbidity

• Close monitoring for patients with high risk of airway deterioration postopera-

• A plane of management of the difficult airway postoperatively should be

importance as both are working in the same field (shared airway).

remained intubated or to do tracheostomy before extubation.

proper training and to be aware of the relevant guidelines.

• If expecting airway problem postoperatively, then the patient should be

• Using the trans-nasal high-flow rapid insufflation ventilator exchange ("THRIVE") makes intubation and extubation less stressful and less

• Staff dealing with patients either intubated or tracheostomized should receive

OSA is considered one of the important challenges in the peri-operative airway management. Obstructive apneas are defined as complete or near-complete cessation of airflow lasting for at least 10 sec. Obstructive hypopneas are characterized by at least 30% reduction in airflow for a minimum of 10 sec and are associated

The difficult airway in OSA patients is considered to be a main contributing factor to the higher rate of adverse respiratory and cardiovascular events, so to reduce the peri-operative complication [19], it is better to divide the management approach of OSA patients into: preoperative, intraoperative, and postoperative

• A planned protocol should be developed for urgent airway management.

**6. Airway management in obstructive sleep apnea (OSA) patients**

• Cooperation and harmony between anesthetists and surgeons are of extreme

The decision to whether manage postoperative difficult airway interventions in ICU or in theater will depend on the clinical problem, availability of equipment, the

management and whom to call in case of airway deterioration.

urgency of the situation, and the relative proximity to theaters [12].

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strategies.
