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Strategies in Postoperative Analgesia in the Obese Obstructive Sleep Apnea Patient

Porhomayon, Jahan MD, FCCP*; Leissner, Kay B. MD, PhD†,‡; El-Solh, Ali A. MD, MPH§; Nader, Nader D. MD, PhD, FCCP

doi: 10.1097/AJP.0b013e31827c7bc7
Review Articles

Objective: Obstructive sleep apnea (OSA) has become an epidemic worldwide, and OSA patients frequently present for surgery. Comorbidities such as cardiovascular disease, diabetes, hypertension, stroke, gastrointestinal disorder, metabolic syndrome, chronic pain, delirium, and pulmonary disorder increase the perioperative risk for OSA patients.

Methods: This is a narrative review of the impact of sedative and analgesic therapy on the intraoperative and postoperative course of an obese OSA patient.

Results: An understanding of postoperative complications related to OSA and drug interactions in the context of opioid and nonopioid selection may benefit pain practitioner and patients equally.

Conclusions: Management of acute postoperative pain in OSA patient remains complex. A comprehensive strategy is needed to reduce the complications and adverse events related to administration of analgesics and anesthetics.

Departments of *Anesthesiology, Division of Critical Care Medicine

§Medicine, Division of Pulmonary, Critical Care, and Sleep, Medicine

Anesthesiology, Division of Cardiothoracic Anesthesia and Pain Medicine, VA Western New York Healthcare System, Buffalo School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY

Division of Anesthesia and Critical Care Medicine, VA Boston Healthcare System, Boston University School of Medicine, West Roxbury

Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

The authors declare no conflict of interest.

Reprints: Jahan Porhomayon, MD, FCCP, VA Medical Center, Rm 203C, 3495 Bailey Ave, Buffalo, NY 14215 (e-mail:

Received May 10, 2012

Accepted November 4, 2012

© 2013 by Lippincott Williams & Wilkins