8. Nonpharmacological options to pain management

The nonpharmacological options are summarized in Table 3:

#### Peripheral therapies (physical skin stimulation)


be continued in all postoperative OSA patients until they maintain preoperative (baseline)

Management of Acute Pain in Obese Patients with Sleep Apnea

http://dx.doi.org/10.5772/intechopen.80350

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Use of CPAP in PACU is recommended for OSA patients who were using it preoperatively at home and also when patients get frequent attacks of airway obstruction in the recovery room [91, 94]. It should also be continued on the inpatient units. CPAP has shown to reduce the incidences of apnea and hypopnea episodes when compared to the preoperative baseline. CPAP is associated with improved ventilation in postoperative OSA patient and also it has

Patients who receive long-acting opioids should be monitored closely and may need high dependency unit admission for postoperative monitoring. Indications for obese patients with OSA for HDU or ICU admission are preexisting co-morbidities, limited functional capacity, major surgery, poorly controlled OSA requiring systemic opioids. The patient should be discharged to the unmonitored settings only when adequate oxygen saturation is maintained to baseline level on room air and with no more risk of respiratory depression (apnea or

hypopnea) that can be determined ideally when the patient is asleep [91].

NIPPV, that could relieve the upper airway obstruction.

, Ahmed Zaghw<sup>2</sup>

Mohammed Azizuddin Imran<sup>3</sup> and Malek Alali2

2 Hamad Medical Corporation, Doha, Qatar

\*Address all correspondence to: ahmedzaghw@gmail.com

3 Women's Wellness and Research Center, Doha, Qatar

1 John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA

Author details

Sayed Rahman<sup>1</sup>

10. Recommendations from guidelines in obese patients with OSA

\*, Osama Elazzouny<sup>2</sup>

, Dhari Almenshid<sup>2</sup>

, Mustafa Rezk2

,

High-risk OSA patients should be managed by a dedicated specialized anesthesia team. Regional anesthetic technique or nonopioids analgesics should be used to reduce the need for systemic opioids. Meticulous monitoring is required when sedatives and opioids are used in suspected or OSA patients due to high risk of respiratory depression. Even HDU or ICU admission for monitoring could be considered if obesity is associated with other co-morbidities. OSA and its complications should be anticipated in obese patient. Postoperative use of supplemental oxygen is recommended as it reduces the incidence of hypoxemic episodes, in addition to CPAP or

oxygen saturation on room air [91].

9.3. Positive airway pressure therapy

shown reduced hospital stay [95–97].

Table 3. Summarization of the nonpharmacological options.
