Jean Wong

The value of screening preoperative chest x-rays: a systematic review

PurposeChestx-ray (CXR) is the most frequently ordered radiological test in Canada. Despite published guidelines, variable policies exist amongst different hospitals for ordering of preoperative CXRs. The purpose of this study was to systematically review the literature on the value of screening CXRs and establish evidence to support guidelines for the use of preoperative screening CXRs.SourceMedline and Embase were searched under set terms for all English language articles published during 1966–2004. All eligible studies were reviewed and data were extracted individually by two authors. Of the 513 articles identified, 14 studies met both inclusion and exclusion criteria.Principal findingsThe quality of published evidence was modest as only six of the studies were rated as fair and eight as poor. Of the reported studies, diagnostic yield increased with age. However, most of the abnormalities consisted of chronic disorders such as cardiomegaly and chronic obstructive pulmonary disease (up to 65%). The rate of subsequent investigations was highly variable (4–47%). When further investigations were performed, the proportion of patients who had a change in management was low (10% of investigated patients). Postoperative pulmonary complications were also similar between patients who had preoperative CXRs (12.8%) and patients who did not (16%).ConclusionAn association between preoperative screening CXRs and decrease in morbidity or mortality could not be established. As the prevalence of CXR abnormalities is low in patients under the age of 70, there is fair evidence that routine CXRs should not be performed for patients in this age group without risk factors. For patients over 70, there is insufficient evidence for or against performance of routine CXRs. The current recommendation from the Guidelines Association Committee that routine CXRs should not be performed for patients over 70 without risk factors is supported by this study.RésuméObjectifLa radiographie pulmonaire (RXP) est le test radiologique le plus demandé au Canada. Malgré les directives publiées, différentes politiques de demande de RXP préopératoires existent dans les hôpitaux. Nous voulions faire une revue systématique des documents sur la valeur des RXP de dépistage préopératoire et établir une preuve appuyant les directives sur leur usage.SourceNous avons passé en revue les bases Medline et Embase sous des termes déterminés pour tous les articles en anglais publiés de 1966 à 2004. Toutes les études admissibles ont été revues et les données extraites isolément par deux auteurs. Des 513 articles retenus, 14 études répondaient aux critères d’inclusion et d’exclusion.Constatations principalesLa qualité de la preuve publiée était modeste, car seulement six études ont été cotées acceptables et huit pauvres. Dans ces études, le rendement diagnostique augmentait avec l’âge. Cependant, la majorité des anomalies étaient des troubles chroniques comme la cardiomégalie et la maladie pulmonaire obstructive chronique (jusqu’à 65 %). Le taux d’examens subséquents était très variable (4–47 %). Quand d’autres tests étaient effectués, une faible proportion (10 % des patients testés) de patients voyaient leur traitement modifié. Les complications pulmonaires postopératoires étaient aussi similaires chez les patients qui avaient eu (12,8 %) ou non (16 %) des RXP préopératoires.ConclusionUne association entre les RXP de dépistage préopératoire et une baisse de la morbidité ou de la mortalité n’a pas pu être établie. Comme la prévalence des anomalies détectées lors des RXP était faible chez les patients de moins de 70 ans, il semble évident que des RXP de routine ne devraient pas être réalisés pour les patients de ce groupe d’âge sans facteurs de risque. Pour les patients de plus de 70 ans, la preuve est insuffisante pour décider s’il y a lieu de procéder à des RXP de routine. La recommandation actuelle du Comité des directives de l’Association voulant que les RXP de routine ne soient pas réalisés pour les patients de plus de 70 ans sans facteurs de risque est soutenue par notre étude.

The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: A systematic review and meta-analysis

BACKGROUND:Obstructive sleep apnea (OSA) is a commonly encountered comorbid condition in patients undergoing surgery and is associated with a greater risk of postoperative adverse events. Our objective in this review was to investigate the effectiveness of continuous positive airway pressure (CPAP) in reducing the risk of postoperative adverse events in patients with OSA undergoing surgery, the perioperative Apnea-Hypopnea Index (AHI), and the hospital length of stay (LOS). METHODS:We performed a systematic search of the literature databases. We reviewed the studies that included the following: (1) adult surgical patients (>18 years old) with information available on OSA; (2) patients using either preoperative and/or postoperative CPAP or no-CPAP; (3) available reports on postoperative adverse events, preoperative and postoperative AHI, and LOS; and (4) all published studies in English including case series. RESULTS:Six studies that included 904 patients were eligible for the meta-analysis. The meta-analysis for postoperative adverse events was performed in 904 patients (CPAP: n = 471 vs no-CPAP: n = 433; adverse events: 134 vs 133; P = 0.19). There was no significant difference in the postoperative adverse events between the 2 groups. The preoperative baseline AHI without CPAP was reduced significantly with postoperative use of CPAP (preoperative AHI versus postoperative AHI, 37 ± 19 vs 12 ± 16 events per hour, P < 0.001). LOS showed a trend toward significance in the CPAP group versus the no-CPAP group (4.0 ± 4 vs 4.4 ± 8 days, P = 0.05). CONCLUSIONS:Our review suggests that there was no significant difference in the postoperative adverse events between CPAP and no-CPAP treatment. Patients using CPAP had significantly lower postoperative AHI and a trend toward shorter LOS. There may be potential benefits in the use of CPAP during the perioperative period.

Tranexamic acid reduces blood transfusion in surgical patients while its effects on thromboembolic events and mortality are uncertain

Commentary on: Ker K, Edwards P, Perel P, et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012;344:e3054.[OpenUrl][1][Abstract/FREE Full Text][2]nnSurgical trauma leads to the activation of local fibrinolysis, and surgical bleeding can be significant in certain types of surgery leading to acute anaemia and the need for blood transfusion. Clinical trends have led to reductions in acceptable haemoglobin transfusion thresholds. However, growing evidence from clinical and experimental studies suggests that acute haemodilutional anaemia may reduce tissue oxygen delivery and increase perioperative morbidity and mortality.1 Therefore, there is renewed interest in antifibrinolytic agents that may reduce surgical bleeding. Surgical trauma also leads to activation of the coagulation cascade and increases the risk for thromboembolic events. Therefore, the risks of thromboembolic and other adverse effects and the benefits of antifibrinolytic agents …nn [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.e3054%26rft_id%253Dinfo%253Apmid%252F22611164%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actxn [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=344/may17_1/e3054&atom=%2Febmed%2F18%2F2%2F65.atom

Improved esophageal patency when inserting the ProSeal™ laryngeal mask airway with an Eschmann™ tracheal tube introducer

PurposeWe hypothesized that a more accurate alignment of the tip of the drain tube with the upper esophageal opening would be achieved in adult patients, as confirmed by fibreoptic bronchoscopy, by placing the ProSeal™ laryngeal mask airway (PLMA) by means of guiding it over an Eschmann™ tracheal tube introducer, commonly know as a gum elastic bougie (GEB), that was previously inserted into the esophagus, rather than by placing the PLMA with a curved metal introducer (IT).MethodsSeventy-five adult elective surgery patients, whose airway management involved a PLMA, were randomly allocated to either the GEB- or IT-guided techniques. After inserting the PLMA, alignment of the tip of the drain tube relative to the esophageal opening was verified by a fibrescope introduced through the drain tube. Placing the fibrescope through the PLMA identified the glottic structures. The primary endpoint indicating the proper alignment of the tip of the drain tube of the PLMA with the upper esophageal opening was the ability to pass the fibrescope into the esophagus through the drain tube by a distance >35xa0cm without obstruction and the ability to simultaneously visualize the esophageal mucosa.ResultsThe overall success rates of PLMA insertion were similar in the GEB and IT groups. However, the mean airway insertion times were longer with the GEB than with the IT-PLMA. The GEB group achieved proper alignment of the drain tube and the upper esophageal opening more frequently than the IT group (97% confidence interval (CI95) 91.5–100% vs 81% CI95 68.5–93.5% of subjects, respectively; Pxa0=xa00.027). When the GEB was used to place the PLMA, the patients’ vocal cords were visualized more frequently than when the IT technique was used (100% vs 73% CI95 58.9–87.1% of subjects, respectively; Pxa0=xa00.003).ConclusionFibreoptic bronchoscopy confirmed that GEB is superior to the IT technique in ensuring precise alignment of the tip of the drain tube of the PLMA with the upper esophageal opening. Accurate positioning may better preserve gastroesophageal drainage function of the PLMA.RésuméObjectifNous avons émis l’hypothèse qu’il serait possible de parvenir à un alignement plus précis entre la pointe du tube de drainage du masque laryngé et l’ouverture supérieure de l’œsophage chez les patients adultes, évalué par bronchoscopie par fibres optiques, en plaçant un masque laryngé ProSeal™ (PLMA) guidé par une bougie de Eschmann™, aussi connue sous le nom de bougie flexible (GEB), insérée précédemment dans l’œsophage, au lieu de placer le PLMA à l’aide d’un introducteur en métal courbé (IT).MéthodeSoixante-quinze patients adultes devant subir une chirurgie non urgente et dont la prise en charge respiratoire impliquait un PLMA on été randomisés en deux groupes à recevoir soit la technique guidée par GEB soit la technique guidée par IT. Aprèsxa0l’insertion du PLMA, l’alignement entre la pointe du tube de drainage et l’ouverture de l’œsophage a été vérifié à l’aide d’un fibroscope introduit via le tube de drainage. Le fait de placer le fibroscope via le PLMA a permis d’identifier les structures glottiques. La capacité de faire passer le fibroscope dans l’œsophage via le tube de drainage sur une distance >35xa0cm sans obstruction et la capacité de visualiser simultanément la muqueuse oesophagienne ont constitué les critères principaux indiquant l’alignement correct entre la pointe du tube de drainage du PLMA et l’ouverture supérieure de l’œsophage.RésultatsLes taux globaux de réussite de l’insertion du PLMA étaient comparables dans les groupes GEB et IT. Toutefois, les temps moyens d’insertion des dispositifs étaient plus longs dans le groupe GEB par rapport au groupe IT-PLMA. Un alignement adéquat du tube de drainage et de l’ouverture supérieure de l’œsophage a été réalisé dans le groupe GEB plus souvent que dans le groupe IT (intervalle de confiance 97 % (IC95) 91,5–100 % vs 81 % IC95 68,5–93,5 % des patients, respectivement; Pxa0=xa00,027). Lors de l’utilisation de la GEB pour placer le PLMA, les cordes vocales des patients étaient plus souvent visualisées que lors de l’utilisation de la technique IT (100 % vs 73 % IC95 58,9–87,1 % des patients, respectivement; Pxa0=xa00,003).ConclusionLa bronchoscopie par fibres optiques a confirmé que la technique GEB est supérieure à la technique IT pour assurer un alignement précis entre la pointe du tube de drainage du PLMA et l’ouverture supérieure de l’œsophage. Un positionnement précis pourrait préserver la fonction de drainage gastro-oesophagien du PLMA de façon plus optimale.

Smoking Cessation: The Role of the Anesthesiologist.

Smoking increases the risk of postoperative morbidity and mortality. Smoking cessation before surgery reduces the risk of complications. The perioperative period may be a “teachable moment” for smoking cessation and provides smokers an opportunity to engage in long-term smoking cessation. Anesthesiologists as the perioperative physicians are well-positioned to take the lead in this area and improve not only short-term surgical outcomes but also long-term health outcomes and costs. Preoperative interventions for tobacco use are effective to reduce postoperative complications and increase the likelihood of long-term abstinence. If intensive interventions (counseling, pharmacotherapy, and follow-up) are impractical, brief interventions should be implemented in preoperative clinics as a routine practice. The “Ask, Advise, Connect” is a practical strategy to be incorporated in the surgical setting. All anesthesiologists should ask their patients about smoking and strongly advise smokers to quit at every visit. Directly connecting patients to existing counseling resources, such as telephone quitlines, family physicians, or pharmacists using fax or electronic referrals, greatly increases the reach and the impact of the intervention.

The prevention of delirium in elderly with obstructive sleep apnea (PODESA) study: protocol for a multi-centre prospective randomized, controlled trial

BackgroundDelirium is a common problem that occurs in 5–50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway – are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium. However, few studies have investigated the effect of perioperative treatment of OSA to prevent postoperative delirium.MethodsThis multi-centre randomized controlled trial will enrol 634 elderly patients undergoing elective hip/knee replacement surgery. The study has been approved by the Research Ethics Boards of the three participating institutions. Patients will be screened with the STOP-Bang questionnaire. Those with a score of 3 or greater will have a portable home sleep study using the ApneaLink™ Air device. Patients identified to have OSA will be randomized to 1) Auto-titrating continuous positive airway pressure (APAP) applied during sleep for 72xa0h after surgery or until discharge if they are discharged before 72xa0h or 2) Control group – routine care, no APAP. All patients will be evaluated for delirium for 72xa0h after surgery or until discharge if they are discharged before 72xa0h. The primary outcome is the occurrence of delirium – assessed twice daily using the Confusion Assessment Method for 72xa0h or until discharge if the hospital stay is <72xa0h.DiscussionDelirium is associated with increased morbidity and mortality, and higher healthcare costs. With the aging population, the incidence of postoperative delirium will likely increase as the number of elderly individuals undergoing surgery rises. The results of our study will be published in a peer-reviewed journal and presented at local and international medical conferences. Our study findings may lead to improved surgical outcomes, enhanced patient safety and reduced healthcare costs.Trial registrationThis study was retrospectively registered at clinicaltrials.gov NCT02954224 on November 3, 2016.

Anesthetic Management of Narcolepsy Patients during Surgery: A Systematic Review

BACKGROUND: Narcolepsy is a rare sleep disorder characterized by excessive daytime sleepiness, sleep paralysis, and/or hypnagogic/hypnopompic hallucinations, and in some cases cataplexy. The response to anesthetic medications and possible interactions in narcolepsy patients is unclear in the perioperative period. In this systematic review, we aim to evaluate the current evidence on the perioperative outcomes and anesthetic considerations in narcolepsy patients. METHODS: Electronic literature search of Medline, Medline in-process, Embase, Cochrane Database of Systematic Reviews databases, international conference proceedings, and abstracts was conducted in November 2015 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. A total of 3757 articles were screened using a 2-stage strategy (title-abstract followed by full text). We included case studies/series, cohort studies, and randomized controlled trials of narcolepsy patients undergoing surgical procedures under anesthesia or sedation. Preoperative narcolepsy symptoms and sleep study data, anesthetic technique, and perioperative complications were extracted. Screening of articles, data extraction, and compilation were conducted by 2 independent reviewers and any conflict was resolved by the senior author. RESULTS: A total of 19 studies including 16 case reports and 3 case series were included and evaluated. The majority of these patients received general anesthesia, whereas a small percentage of patients received regional anesthesia. Reported complications of narcolepsy patients undergoing surgeries were mainly related to autonomic dysregulation, or worsening of narcolepsy symptoms intra/postoperatively. Narcolepsy symptoms worsened only in those patient populations where the preoperative medications were either discontinued or reduced (mainly in obstetric patients). In narcolepsy patients, use of depth of anesthesia monitoring and total intravenous technique may have some advantage in terms of safety profile. Several patients undergoing neurosurgery involving the hypothalamus or third or four ventricles developed new-onset narcolepsy. CONCLUSIONS: We found a paucity of prospective clinical trials in this patient population, as most of the studies were case reports or observational studies. Continuation of preoperative medications, depth of anesthesia monitoring, use of multimodal analgesia with short-acting agents and regional anesthesia techniques were associated with favorable outcomes. Obstetric patients may be at greater risk for worsening narcolepsy symptoms, possibly related to a reduction or discontinuation of medications. For neurosurgical procedures involving the hypothalamus or third and fourth ventricle, postoperative considerations should include monitoring for symptoms of narcolepsy. Future studies are needed to better define perioperative risks associated with anesthesia and surgery in this population of patients.

In reply: Optimal propofol induction dose in morbidly obese patients: bispectral index guidance is not the answer

To the Editor, We thank Dr. Chiravuri and colleagues for their valuable comments on our randomized controlled trial. Dr. Chiravuri indicated that the bispectral index (BIS) is a brain-state monitor and was not designed to guide anesthetic induction. However, there is precedent in the literature that a BIS target of 50 may be used as an end point of induction. Because of the lack of data in the literature, our objective was to determine if the BIS monitor is an appropriate approach to guiding induction of anesthesia in morbidly obese (MO) patients. In their letter, Chiravuri et al. stated that the two groups were randomized as follows: ‘‘Propofol dosing based on: 1) the calculated lean body weight (LBW group), or 2) propofol infusion 100 mg kg hr to an initial targeted BIS of 50 (BIS group).’’ We want to clarify that both the LBW and the BIS groups received the same propofol infusion of 100 mg kg hr based on the LBW. The LBW was calculated based on the Janmahasatian equation. The LBW group received this infusion until a predetermined dose of 2.6 mg kg LBW was reached, whereas the BIS group received the infusion until a BIS target of 50 was reached. As explained in our article, the BIS target of 50 is based on studies by Gürses et al. and Arya et al., which compared the clinical end point of the loss of verbal response with BIS for induction with propofol, using a mean (standard deviation) BIS of 48 (2) as an end point for induction. The 2.6 mg kg LBW dose of propofol was based on the results obtained in the study conducted by Ingrande et al., which showed that the LBW scalar is appropriate for inducing MO patients with propofol. This initial dosing was defined as a target point. However, the infusion was continued until the Observer’s Assessment of Alertness/Sedation Scale was 0, which was taken as an end point for induction. The doses at the target points and infusion end points are reported based on both total body weight and LBW for both groups in Table 3 of our article. We emphasize that both groups received the infusion in the same manner, but the targets were different – i.e., LBW-based dosing vs BIS-based dosing. We agree that MO patients should be included during the drug-development stage because there is currently no consensus on dosing of anesthetic agents in MO patients due to the paucity of data. This is particularly important given the obesity epidemic. Our study – one of the very few studies examining the application of BIS for anesthetic induction in MO patients – provides promise that BIS may be useful in this regard.

Comparison of oropharyngeal leak pressure between the Ambu® AuraGain™ and the LMA® Supreme™ supraglottic airways: a randomized-controlled trial

PurposeStudies comparing the recently introduced Ambu® AuraGain™ (Auragain) with the LMA® Supreme™ (Supreme) supraglottic airway (SGA) have reported conflicting results regarding differences in oropharyngeal leak pressure (OLP). This randomized-controlled trial investigated the OLP of the Auragain compared with the Supreme in patients undergoing ambulatory surgery.MethodsAdult patients with a body mass index ≤ 40 kg·m−2 presenting for ambulatory surgery and requiring an SGA were randomized to receive either the Auragain or the Supreme. Anesthesia was induced with lidocaine (1 mg·kg−1), fentanyl (1-2 μg·kg−1), and propofol (2-3 mg·kg−1). The SGA was inserted using a standard technique with the cuff inflated to 60 cmH2O. The groups were compared for the primary outcome of OLP.ResultsOne hundred sixty-five patients (n = 81, Auragain; n = 84, Supreme) completed the study. Demographics were similar between the groups. The mean (standard deviation [SD]) OLP was significantly higher in the Auragain than in the Supreme group [26.4 (2.8) cmH2O vs 21.6 (3.4) cmH2O, respectively; difference in means (MD), 4.8 cmH2O; 95% confidence interval (CI), 3.9 to 5.8; P < 0.001]. The mean (SD) insertion time was longer in the Auragain than in the Supreme group [13 (4) sec vs 11 (3) sec, respectively; MD, 2 sec; 95% CI, 1 to 3 sec; P < 0.001].ConclusionIn patients undergoing ambulatory anesthesia, the OLP was higher but took longer to insert with the Auragain than with the Supreme. A higher OLP may allow for SGAs to be utilized in a wider range of patients and procedures.Trial registrationwww.clinicaltrials.gov (NCT02816463). Registered 28 June 2016.RésuméObjectifDes études comparant les voies respiratoires supraglottiques (SGA) Ambu® AuraGain™ (Auragain) nouvellement commercialisé et LMA® Supreme™ (Supreme) ont fourni des résultats contradictoires concernant les différences de pressions de fuite oropharyngée (OLP). Cet essai randomisé contrôlé a étudié l’OLP de l’Auragain comparativement à celle du Supreme chez des patients subissant une chirurgie ambulatoire.MéthodesDes patients adultes ayant un indice de masse corporelle ≤xa040xa0kg·xa0m−2 venant pour chirurgie ambulatoire et nécessitant une SGA ont été randomisés pour bénéficier de l’Auragain ou du Supreme. L’anesthésie a été induite avec de la lidocaïne (1xa0mg·xa0kg−1), du fentanyl (1-2xa0μg·kg−1) et du propofol (2-3xa0mg·xa0kg−1). La SGA a été insérée selon une technique standard et le ballonnet a été gonflé à 60xa0cmH2O. Le principal critère d’évaluation comparé entre les deux groupes était l’OLP.RésultatsCent soixante-cinq patients (nxa0=xa081, Auragain; nxa0= 84, Supreme) ont terminé l’étude. Les données démographiques étaient similaires entre les groupes. L’OLP moyenne (écart-type [ÉT]) était significativement plus élevée dans le groupe Auragain que dans le groupe Supreme (respectivement, 26,4 [2,8] cmH2O contre 21,6 [3,4] cmH2O; différence des moyennes, 4,8xa0cmH2O; intervalle de confiance [IC] à 95xa0%xa0: 3,9 à 5,8; Pxa0<xa00,001). Le temps moyen (ÉT) d’insertion a été plus long dans le groupe Auragain que dans le groupe Supreme (respectivement, 13 [4]xa0s contre 11 [3]xa0s; différence des moyennes, 2xa0s; IC à 95xa0%, 1 à 3xa0s; Pxa0<xa00,001).ConclusionChez les patients subissant une anesthésie ambulatoire, l’OLP a été plus élevée avec l’Auragain qu’avec le Supreme, mais son insertion a pris plus de temps. Une OLP plus élevée pourrait permettre d’utiliser les SGA dans un plus vaste éventail de procédures et de patients.Enregistrement de l’essai cliniquewww.ClinicalTrials.gov (NCT02816463). Enregistré le 28xa0juinxa02016.

Patient preference survey: are patients willing to delay surgery if obstructive sleep apnea is suspected?

BackgroundScreening and optimizing patients for OSA in the perioperative period may reduce postoperative complications. However, sleep studies can be difficult to obtain before surgery. Previous surveys reported that the majority of sleep physicians would delay surgery to diagnose and manage OSA, but most anesthesiologists would not. While disagreements exist, the importance of shared decision making and patient preferences have never been studied on this topic. It is unknown whether patients with suspected OSA, when given information about OSA, would be willing to delay surgery to diagnose and manage their condition preoperatively.MethodsThis study consisted of a self-administered questionnaire that surveyed patients, patient relatives, or any accompanying members. The survey was conducted in the preoperative clinic or in the perioperative patient and family waiting area at two hospitals in Canada and in the United States. A hypothetical scenario was used: participants were given information about OSA, and asked about their preferences regarding preoperative management should they be at risk for OSA in the setting of pending elective surgery. The objective of this study was to determine whether respondents preferred to 1) proceed with surgery as planned, 2) delay surgery to ensure the medical condition of OSA is diagnosed and optimized, or 3) let his/her physician decide.ResultsThe final survey contained 19 questions and the survey was conducted from June 2016 to September 2016. Four hundred and seventy-three surveys were collected. Forty-four percent of respondents, when given information about OSA, preferred to delay surgery pending a sleep study and treatment. Forty percent of respondents who preferred to delay surgery would tolerate delaying up to two months.ConclusionIncreasing emphasis and significant value has been placed on shared-decision making between patients and physicians. Educating patients about the risks of OSA and incorporating patient preferences into the perioperative management of OSA may be warranted.