Reduced Recovery Times with Total Intravenous Anesthesia in Patients with Obstructive Sleep Apnea. (3rd November 2020)

• Record Type: Journal Article
• Authors: Stewart, Matthew; Estephan, Leonard; Thaler, Adam; Zhan, Tingting; Connors, Kevin; Malkani, Kabir; Hunt, Patrick; Boon, Maurits; Huntley, Colin
• Is Part Of: Laryngoscope. Volume 131:Number 4(2021)
• Page Start: 925
• Page End: 931
• Publication Date: 2020-11-03
• Subjects: Tiva -- recovery -- anesthesia -- obstructive sleep apnea -- upper airway stimulation; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.29216
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: There is currently no standard of care in terms of anesthesia modality for patients receiving upper airway surgery with comorbid obstructive sleep apnea (OSA). Although both total intravenous anesthesia (TIVA) and volatile gas anesthesia are commonly utilized in ambulatory otolaryngology surgery, it is currently unclear if there are any advantages with one modality over the other. We hypothesize that patients receiving upper airway surgery with comorbid OSA will have quicker recovery times with TIVA. Study Design: Retrospective chart review from January 2019 to December 2019. Methods: All patients aged 18 and older receiving upper airway surgery (upper airway stimulation, nasal surgery, modified uvulopalatopharyngoplasty) were included. Patients were excluded when there was incomplete or missing data in the electronic medical record. Results: Eighty‐six patients received gas anesthesia and 62 patients received TIVA. Phase I recovery times were significantly reduced by surgery and by severity of OSA: nasal surgery, upper airway stimulation, and modified uvulopalatopharyngoplasty had a reduction of 35.5 minutes ( P < .001), 42.5 minutes ( P < .001), and 36 minutes ( P = .022), respectively. In terms of severity, mild, moderate, and severe OSA had reductions of 23.5 minutes ( P = .004), 52 minutes ( P = .004), and 47 minutes ( P < .001), respectively. The severity of OSA generally correlated with increased time spent in Phase I: as severity increased, Phase I time increased by 16.8 minutes for the gas cohort ( P < .001), whereas in the TIVA cohort, it increased only 4.3 minutes ( P = .489). Conclusion: Patients having upper airway surgery with comorbid OSA that received TIVA (propofol and remifentanil) spent significantly less time in Phase I and the recovery room overall compared to those receiving volatile gas anesthesia in the form of sevoflurane, and this correlated with the severity of OSA. Level of Evidence: 3. Laryngoscope, 131:925–931, 2021