Ziad Shaman

Perioperative Complications in Obstructive Sleep Apnea Patients Undergoing Surgery: A Review of the Legal Literature.

BACKGROUND:Obstructive sleep apnea (OSA) is common in patients undergoing surgery. OSA, known or suspected, has been associated with significant perioperative adverse events, including severe neurologic injury and death. This study was undertaken to assess the legal consequences associated with poor outcomes related to OSA in the perioperative setting. METHODS:A retrospective review of the legal literature was performed by searching 3 primary legal databases between the years 1991 and 2010 for cases involving adults with known or suspected OSA who underwent a surgical procedure associated with an adverse perioperative outcome. OSA had to be directly implicated in the outcome, and surgical mishaps (i.e., uncontrolled bleeding) were excluded. The adverse perioperative outcome had to result in a lawsuit that was then adjudicated in a court of law with a final decision rendered. Data were abstracted from each case regarding patient demographics, type of surgery, type and location of adverse event, associated anesthetic and opioid use, and legal outcome. RESULTS:Twenty-four cases met the inclusion criteria. The majority (83%) occurred in or after 2007. Patients were young (average age, 41.7 years), male (63%), and had a known diagnosis of OSA (96%). Ninety-two percent of cases were elective with 33.3% considered general procedures, 37.5% were ears, nose and throat procedures for the treatment of OSA, and 29.1% were considered miscellaneous interventions. Complications occurred intraoperatively (21%), in the postanesthesia care unit (33%), and on the surgical floors (46%). The most common complications were respiratory arrest in an unmonitored setting and difficulty in airway management. Immediate adverse outcomes included death (45.6%), anoxic brain injury (45.6%), and upper airway complications (8%). Overall, 71% of the patients died, with 6 of the 11 who suffered anoxic brain injury dying at an average of 113 days later. The use of opioids and general anesthetics was believed to play a role in 38% and 58% of cases, respectively. Verdicts favored the plaintiffs in 58% of cases and the defendants in 42%. In cases favoring the plaintiff, the average financial penalty was

Impact of Upper Airway Surgery on CPAP Compliance in Difficult-to-Manage Obstructive Sleep Apnea

2.5 million (±

Sleep and Organ Physiology

2.3 million; range,

Physician-attributable differences in intensive care unit costs: A single-center study

650,000––

Findings of a Berlin Questionnaire survey: Comparison between patients seen in an asthma clinic versus internal medicine clinic

7.7 million). CONCLUSIONS:Perioperative complications related to OSA are increasingly being reported as the central contention of malpractice suits. These cases can be associated with severe financial penalties. These data likely underestimate the actual medicolegal burden, given that most such cases are settled out of court and are not accounted for in the legal literature.

Pulse Pressure and Carotid Artery Doppler Velocimetry as Indicators of Maternal Volume Status: A Prospective Cohort Study

OBJECTIVE To study the role of adjunctive upper airway surgery in obese patients with obstructive sleep apnea (OSA) who were poorly compliant with continuous positive airway pressure (CPAP) therapy. DESIGN Retrospective study of obese patients with OSA and documented poor CPAP compliance who underwent noncurative upper airway surgery for anatomical obstruction. Data collected included polysomnogram (PSG) parameters, CPAP settings and compliance, and surgical complications. SETTING An urban academic county hospital with an 8-bed sleep laboratory. Data were collected retrospectively from 2002 through 2005. PATIENTS Subjects who met the following criteria: (1) documented OSA (apnea-hypopnea index [AHI] > or =5.0) treated with CPAP therapy, (2) poor CPAP compliance (<4 hours per night), (3) subjected to upper airway surgery, (4) repeated PSG after surgery revealed persistent OSA (AHI > or = 5) requiring continued treatment with CPAP, and (5) availability of presurgery and postsurgery CPAP compliance data. MAIN OUTCOME MEASURE Compliance with CPAP. RESULTS Data from 11 patients were available for analysis. Their PSG parameters revealed the mean AHI (79.0 before surgery vs 30.2 after surgery; P < .001) and mean CPAP pressure setting (11.8 cm H(2)O before surgery vs 10.4 cm H(2)O after surgery; P = .09) improved following surgery. A mean increase of 48.6 minutes in CPAP compliance was noted after surgery (P = .03). Eight of the 11 patients improved their CPAP compliance following surgical intervention, including 5 who improved by more than 1 hour. CONCLUSION Upper airway surgery in select patients with OSA may improve CPAP compliance and should be considered as a potential adjunctive therapeutic measure in poorly compliant patients with OSA.

750: Pulse pressure and carotid artery doppler velocimetry as indicators of maternal volume status: a prospective cohort study

The physiological effect of sleep on the body’s organ systems is modulated by closed feedback loops. Due to this feedback system, a major disturbance in sleep is highly likely to affect the function and homeostasis of the body as a whole. Similarly, pathological changes in any individual organs may lead to a significant change in sleep structure and organization. This chapter will focus on the effect that sleep and specific organ physiology have on each other, focusing on the physiology of the autonomic nervous system as well as the cardiovascular, gastrointestinal, endocrine, thermoregulatory, and immune systems.