About postanesthetic apnea
What is postanesthetic apnea?
Respiratory depression (hypoventilation) is a breathing disorder characterized by slow and ineffective breathing.
During a normal breathing cycle, you inhale oxygen into your lungs. Your blood carries the oxygen around your body, delivering it to your tissues. Your blood then takes the carbon dioxide, a waste product, back to your lungs. The carbon dioxide exits your body when you exhale.
During hypoventilation, the body can’t adequately remove carbon dioxide. This can lead to poor use of oxygen by lungs. The result is a higher level of carbon dioxide and too little oxygen available to the body.
Hypoventilation is different from hyperventilation. Hyperventilation is when you breathe too quickly, lowering levels of carbon dioxide in the blood.
What are the symptoms for postanesthetic apnea?
Symptoms of respiratory depression vary. Mild or moderate symptoms may include:
- daytime sleepiness
- shortness of breath
- slow and shallow breathing
As the condition progresses and your carbon dioxide level increases, you may develop:
- bluish-colored lips, fingers, or toes
Fast breathing isn’t typical with hypoventilation. However, some people experience faster breathing as their body attempts to blow out excess carbon dioxide.
What are the causes for postanesthetic apnea?
If left untreated, hypoventilation can cause life-threatening complications, including death.
Respiratory depression occurring from a drug overdose can lead to respiratory arrest. This is when breathing completely stops, which is potentially fatal. Ongoing episodes of hypoventilation can also cause pulmonary hypertension, which can cause right-sided heart failure.
What are the treatments for postanesthetic apnea?
For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or quitting smoking. If you have nasal allergies, your doctor will recommend treatment for your allergies.
If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available.
Certain devices can help open up a blocked airway. In other cases, surgery might be necessary.
Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you might benefit from using a machine that delivers air pressure through a mask while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air and is just enough to keep your upper airway passages open, preventing apnea and snoring.
Although CPAP is the most common and reliable method of treating sleep apnea, some people find it cumbersome or uncomfortable. Some people give up on the CPAP machine, but with practice, most people learn to adjust the tension of the straps on the mask to obtain a comfortable and secure fit.
You might need to try more than one type of mask to find one that's comfortable. Don't stop using the CPAP machine if you have problems. Check with your doctor to see what changes can be made to increase your comfort.
Additionally, contact your doctor if you're still snoring or begin snoring again despite treatment. If your weight changes, the pressure settings of the CPAP machine might need to be adjusted.
- Other airway pressure devices. If using a CPAP machine continues to be a problem for you, you might be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping (auto-CPAP). Units that supply bilevel positive airway pressure (BPAP) also are available. These provide more pressure when you inhale and less when you exhale.
Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more reliably effective than oral appliances, but oral appliances might be easier to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea.
A number of devices are available from your dentist. You might need to try different devices before finding one that works for you.
Once you find the right fit, you'll need to follow up with your dentist repeatedly during the first year and then regularly after that to ensure that the fit is still good and to reassess your signs and symptoms.
- Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders, and treating those conditions might help.
- Supplemental oxygen. Using supplemental oxygen while you sleep might help if you have central sleep apnea. Various forms of oxygen are available with devices to deliver oxygen to your lungs.
Adaptive servo-ventilation (ASV). This more recently approved airflow device learns your normal breathing pattern and stores the information in a built-in computer. After you fall asleep, the machine uses pressure to normalize your breathing pattern and prevent pauses in your breathing.
ASV appears to be more successful than other forms of positive airway pressure at treating complex sleep apnea in some people. However, it might not be a good choice for people with predominant central sleep apnea and advanced heart failure.
You'll likely read, hear or see TV ads about different treatments for sleep apnea. Talk with your doctor about any treatment before you try it.
Surgery is usually only an option after other treatments have failed. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for a small number of people with certain jaw structure problems, it's a good first option.
Surgical options might include:
Tissue removal. During this procedure (uvulopalatopharyngoplasty), your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well.
This type of surgery might be successful in stopping throat structures from vibrating and causing snoring. It's less effective than CPAP and isn't considered a reliable treatment for obstructive sleep apnea.
Removing tissues in the back of your throat with radiofrequency energy (radiofrequency ablation) might be an option if you can't tolerate CPAP or oral appliances.
- Tissue shrinkage. Another option is to shrink the tissue at the rear of your mouth and the back of your throat using radiofrequency ablation. This procedure might be used for mild to moderate sleep apnea. One study found this to have effects similar to that of tissue removal, but with fewer surgical risks.
- Jaw repositioning. In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure is known as maxillomandibular advancement.
- Implants. Soft rods, usually made of polyester or plastic, are surgically implanted into the soft palate after you've received local anesthetic. More research is needed to determine how well implants work.
- Nerve stimulation. This requires surgery to insert a stimulator for the nerve that controls tongue movement (hypoglossal nerve). The increased stimulation helps keep the tongue in a position that keeps the airway open. More research is needed.
Creating a new air passageway (tracheostomy). You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe.
You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat.
Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages:
- Surgery to remove enlarged tonsils or adenoids
- Weight-loss (bariatric) surgery
What are the risk factors for postanesthetic apnea?
Factors that increase the risk of this form of sleep apnea include:
- Excess weight. Obesity greatly increases the risk of sleep apnea. Fat deposits around your upper airway can obstruct your breathing.
- Neck circumference. People with thicker necks might have narrower airways.
- A narrowed airway. You might have inherited a narrow throat. Tonsils or adenoids also can enlarge and block the airway, particularly in children.
- Being male. Men are two to three times more likely to have sleep apnea than are women. However, women increase their risk if they're overweight, and their risk also appears to rise after menopause.
- Being older. Sleep apnea occurs significantly more often in older adults.
- Family history. Having family members with sleep apnea might increase your risk.
- Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat, which can worsen obstructive sleep apnea.
- Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who've never smoked. Smoking can increase the amount of inflammation and fluid retention in the upper airway.
- Nasal congestion. If you have difficulty breathing through your nose — whether from an anatomical problem or allergies — you're more likely to develop obstructive sleep apnea.
- Medical conditions. Congestive heart failure, high blood pressure, type 2 diabetes and Parkinson's disease are some of the conditions that may increase the risk of obstructive sleep apnea. Polycystic ovary syndrome, hormonal disorders, prior stroke and chronic lung diseases such as asthma also can increase risk.
Is there a cure/medications for postanesthetic apnea?
Postanesthetic apnea is a condition that can occur after surgery. People with this condition may have difficulty breathing and may need help from a ventilator. There is no cure for postanesthetic apnea, but it is generally a temporary condition that resolves on its own. Medications may be used to help people with this condition breathe more easily.
There is no known cure for postanesthetic apnea. However, there are a few potential treatments that may help to improve the condition. These include:
1. Weight loss: One study found that overweight and obese patients with postanesthetic apnea had a significantly reduced risk of developing the condition after losing weight.
2. Avoiding trigger foods: Some patients have reported that certain foods can trigger postanesthetic apnea episodes. These triggers can vary from person to person, but common ones include dairy products, wheat, and sugar.
3. PAP therapy: A study in rats found that positive airway pressure (PAP) therapy may help to prevent or reduce the severity of postanesthetic apnea.
4. Surgery: In some cases, surgery may be necessary to treat postanesthetic apnea. This is typically only recommended if other treatment options have been unsuccessful.
5. If you believe that you or a loved one may be suffering from postanesthetic apnea, it is important to see a doctor as soon as possible. Early diagnosis and treatment can help to improve the chances of a successful outcome.
Difficulty breathing,Shallow breathing,Apnea episodes (periods of time when breathing stops altogether),Fatigue,Dizziness,Headaches
Positive airway pressure therapy,Surfactant therapy,Certain medications (such as those used to treat heart disease or diabetes)