TY - JOUR
T1 - Perioperative management of obstructive sleep apnea in bariatric surgery
T2 - a consensus guideline
AU - de Raaff, C.A.L.
AU - Gorter-Stam, M.A.W.
AU - de Vries, N.
AU - Sinha, A.C.
AU - Bonjer, H.J.
AU - Chung, F.
AU - Coblijn, U.K.
AU - Dahan, A.
AU - van den Helder, R.S.
AU - Hilgevoord, A.A.J.
AU - Hillman, D.R.
AU - Margarson, M.P.
AU - Mattar, S.G.
AU - Mulier, J.P.
AU - Ravesloot, M.J.L.
AU - Reiber, B.M.M.
AU - van Rijswijk, A.-S.
AU - Singh, P.M.
AU - Steenhuis, R.
AU - Tenhagen, M.
AU - Vanderveken, O.M.
AU - Verbraecken, J.
AU - White, D.P.
AU - van der Wielen, N.
AU - van Wagensveld, B.A.
N1 - With supplementary files
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Background: The frequency of metabolic and bariatric surgery (MBS) is increasing worldwide, with over 500,000 cases performed every year. Obstructive sleep apnea (OSA) is present in 35%–94% of MBS patients. Nevertheless, consensus regarding the perioperative management of OSA in MBS patients is not established. Objectives: To provide consensus based guidelines utilizing current literature and, when in the absence of supporting clinical data, expert opinion by organizing a consensus meeting of experts from relevant specialties. Setting: The meeting was held in Amsterdam, the Netherlands. Methods: A panel of 15 international experts identified 75 questions covering preoperative screening, treatment, postoperative monitoring, anesthetic care and follow-up. Six researchers reviewed the literature systematically. During this meeting, the “Amsterdam Delphi Method” was utilized including controlled acquisition of feedback, aggregation of responses and iteration. Results: Recommendations or statements were provided for 58 questions. In the judgment of the experts, 17 questions provided no additional useful information and it was agreed to exclude them. With the exception of 3 recommendations (64%, 66%, and 66% respectively), consensus (>70%) was reached for 55 statements and recommendations. Several highlights: polysomnography is the gold standard for diagnosing OSA; continuous positive airway pressure is recommended for all patients with moderate and severe OSA; OSA patients should be continuously monitored with pulse oximetry in the early postoperative period; perioperative usage of sedatives and opioids should be minimized.Conclusion: This first international expert meeting provided 58 statements and recommendations for a clinical consensus guideline regarding the perioperative management of OSA patients undergoing MBS.
AB - Background: The frequency of metabolic and bariatric surgery (MBS) is increasing worldwide, with over 500,000 cases performed every year. Obstructive sleep apnea (OSA) is present in 35%–94% of MBS patients. Nevertheless, consensus regarding the perioperative management of OSA in MBS patients is not established. Objectives: To provide consensus based guidelines utilizing current literature and, when in the absence of supporting clinical data, expert opinion by organizing a consensus meeting of experts from relevant specialties. Setting: The meeting was held in Amsterdam, the Netherlands. Methods: A panel of 15 international experts identified 75 questions covering preoperative screening, treatment, postoperative monitoring, anesthetic care and follow-up. Six researchers reviewed the literature systematically. During this meeting, the “Amsterdam Delphi Method” was utilized including controlled acquisition of feedback, aggregation of responses and iteration. Results: Recommendations or statements were provided for 58 questions. In the judgment of the experts, 17 questions provided no additional useful information and it was agreed to exclude them. With the exception of 3 recommendations (64%, 66%, and 66% respectively), consensus (>70%) was reached for 55 statements and recommendations. Several highlights: polysomnography is the gold standard for diagnosing OSA; continuous positive airway pressure is recommended for all patients with moderate and severe OSA; OSA patients should be continuously monitored with pulse oximetry in the early postoperative period; perioperative usage of sedatives and opioids should be minimized.Conclusion: This first international expert meeting provided 58 statements and recommendations for a clinical consensus guideline regarding the perioperative management of OSA patients undergoing MBS.
KW - Anesthesia
KW - Bariatric surgery
KW - Consensus guideline
KW - Continuous positive airway pressure
KW - Obstructive sleep apnea
KW - Postoperative monitoring
UR - http://www.scopus.com/inward/record.url?scp=85021835861&partnerID=8YFLogxK
UR - https://pure.uva.nl/ws/files/29829913/1_s2.0_S1550728917301533_mmc1.docx
UR - https://pure.uva.nl/ws/files/29829915/1_s2.0_S1550728917301533_mmc2.docx
U2 - https://doi.org/10.1016/j.soard.2017.03.022
DO - https://doi.org/10.1016/j.soard.2017.03.022
M3 - Article
C2 - 28666588
SN - 1550-7289
VL - 13
SP - 1095
EP - 1109
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 7
ER -
