Anesthesia Progress – Despite the dosage recommendations that come with all drug packaging, not all recommendations are safe for everyone. The same is true of drugs administered during dental procedures, particularly for sleep apnea patients.
As an editorial in the current issue of the journal Anesthesia Progress explains, dentists must consider a specific patient’s health before sedating the patient. Patients with obstructive sleep apnea (OSA), particularly those who are morbidly obese, can become short of breath, fall unconscious, or even stop breathing if they are given the normal doses of a sedative before dental surgery.
While they sleep, patients suffering from OSA can cycle through periods when they don’t breathe in enough oxygen and retain too much carbon dioxide. When the levels become life threatening, a primitive instinct kicks in and the patient awakens briefly, takes several breaths, and then falls back asleep. But sedatives can override this arousal impulse. OSA patients who don’t wake up to open their airway and breathe can die, either in the dentist’s chair or after returning home if a sufficient amount of the drug is still in their system.
It is important but difficult to recognize who is likely to suffer from OSA. More than 18 million Americans are affected by the disorder, according to the National Sleep Foundation. However, researchers have found that relatively few patients are diagnosed by primary-care doctors and tested in a sleep study laboratory. For undiagnosed patients, dentists can complete a questionnaire that considers the likelihood of OSA based on a patient’s gender, age, body mass index, and several sleep-related factors.
The patients with the most severe OSA are at the greatest risk. Patients known to have the condition are typically graded by the Apnea-Hypopnea Index. Those suspected by the dental surgeon of having OSA can be considered high or low risk depending on their questionnaire results. A thorough medical history and evaluation are necessary, perhaps with the assistance of the patient’s physician and any other medical providers.
It can be risky to sedate any OSA patient. These patients, as well as those who are elderly, debilitated, or severely affected by disease, should be given sedatives with extreme caution.
Full text of the article “Editorial: When can a normal dose be an overdose? Who is at risk?”Anesthesia Progress, Vol. 61, No. 2, 2014, is now available at https://anesthesiaprogress.org/doi/full/10.2344/0003-3006-61.2.45.