Obstrüktif Uyku Apne Sendromunda Perioperatif Değerlendirme
Özet
Obstrüktif Uyku Apne Sendromu (OUAS), uyku sırasında üst solunum yolunun aralıklı tıkanmasıyla karakterize, preoperatif farkındalık ve dikkatli değerlendirme gerektiren yaygın bir uyku bozukluğudur. Perioperatif dönemde bu hastalarda kardiyovasküler komplikasyonlar, yönetilemeyen zor ventilasyon ve güç entübasyon gibi ciddi riskler bulunmaktadır. Tanı için altın standart polisomnografi olsa da preoperatif risk tayininde Berlin ve STOP-BANG anketleri, havayolu değerlendirmesinde ise Mallampati sınıflaması ile tiromental mesafe ölçümü kritik öneme sahiptir. Anestezik ilaçların kas tonusunu azaltarak üst havayolunda kollapsa yol açması nedeniyle supin pozisyondan kaçınılmalı, preoperatif sedatiflerden uzak durulmalı ve zor havayolu ekipmanları hazır bulundurulmalıdır. CPAP cihazı kullanımının cerrahi sonrası komplikasyonları ve hastanede kalış süresini azalttığı gösterilmiştir. Sonuç olarak, anestezi ve cerrahi ekibinin perioperatif süreçte OUAS risklerinin farkında olması, hastaya özgü hazırlıkların yapılması ve multidisipliner bir yaklaşım sergilenmesi, morbidite ve mortalite oranlarını düşürmek açısından hayati bir gerekliliktir.
Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep disorder characterized by intermittent upper airway obstruction during sleep, requiring strict preoperative awareness and meticulous evaluation. During the perioperative period, these patients carry severe risks, including cardiovascular complications, unmanageable difficult ventilation, and challenging endotracheal intubation. Although polysomnography remains the gold standard for diagnosis, the Berlin and STOP-BANG questionnaires are critical for preoperative risk assessment, while the Mallampati classification and thyromental distance measurement are essential for airway evaluation. Since anesthetic agents reduce muscle tone and induce upper airway collapse, avoiding the supine position, refraining from preoperative sedatives, and preparing advanced airway equipment are vital steps. Continuous Positive Airway Pressure (CPAP) device compliance has been shown to reduce postoperative complications and the overall length of hospital stay. Consequently, the anesthesia and surgical teams' comprehensive awareness of perioperative OSAS risks, combined with patient-specific preparations and a multidisciplinary approach, is a fundamental necessity to minimize morbidity and mortality rates.
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