Search

Patients with upper airway obstruction during sleep are at constant risk of hypoxic and hypercarbic episodes and are especially vulnerable during anaesthesia and sedation as the abnormal anatomy is compounded by drug-related respiratory depression. Elective procedures in patients with the obstructive sleep apnoea (OSA) should be usually delayed, allowing for the preoperative home treatment (diet, alcohol abstinence, nasal CPAP/BiPAP during night). Respiratory supportive techniques, started at home, should be continued in the hospital, both in preoperative and postoperative periods. Patients with OSA should be also thoroughly examined for possible anatomic abnormalities of the upper airway that may complicate laryngoscopy and/or intubation. Heavy premedication should be avoided; in special cases of very nervous patients oral clonidine may be used. Careful preoxygenation is mandatory, opioids should be used sparingly. Muscle relaxant should be calculated for an ideal body weight. Isoflurane should be avoided. The OPS and obese patients are usually extubated in the sitting or lateral positions to avoid limitation of FRC by elevated diaphragm. In selected cases, prolonged intubation and/or ventilation are recommended. Regional anaesthesia are usually safe in these patients, however, opioids should be used carefully. When sedation is required, ketamine or dexmedetomidine may be used.

Introduction: Investigators have been interested in the structure and function of the uvula for centuries. Some of them emphasized its influence on the tone of voice, others its immunological role. Since the times of Hippocrates, people have been afraid of the uvula oedema, as it could lead to apnea and death. It was also suspected that upper airway diseases originated from the uvula. That's why excision of the uvula has been a common practice in folk medicine carried out as a ritual act in the North Africa and Middle East for many centuries up to now. Nowadays Evidence Based Medicine recommends uvulectomy as a part of surgical treatement in any form of sleep related obstructive breathing disorders. The aim of this study was to present the specific function of the uvula and draw the practical conclusions concerning uvulopalatopharyngoplasty., Material and Methods: Histological analysis of the uvula and soft palate samples obtained by UPPP from 37 adults suffering from moderate OSAS was performed., Results: This investigation revealed that the uvula contained significantly more salivary glands with predominant serous type in comparison with the palatine arches tissue. Glandular follicles were composed of the pyramid-shaped epithelial cells lying on the basement membrane. Between these there were myoepithelial cells which pushed serous secretion to the excretory ducts., Conclusions: Histologically unique structure of the uvula, when compared with other parts of the soft palate, suggests that the uvula plays a very important role in moistening the oropharyngeal mucosa. Since the feeling of dryness in the throat is one of the most frequent complaints after UPPP, the modification of the standard operative technique in order to preserve the uvula, should be considered.

Introduction: There is abundant conflicting information in the literature about prognostic value of sophisticated, diagnostic tests as well as data from simple clinical examination in its surgical treatment due to the complex nature of OSA. The aim of our study was to assess the efficacy of uvulopalatopharyngoplasty in the treatment of mild and moderate OSA patients who were preliminary selected by simple clinical examination., Material and Method: 20 patients with obstructive sleep apnea syndrome were included in this study. There were patients who met the following criteria: RDI less than 30, BMI less than 30, collar size less than 43 cm, normal nasal potency, modified Mallampati grade I or II, were enrolled in the study. The mean age of the patients was 45,5. Modified Mallampati score was used for evaluation the structures of oropharynx., Results: 55% of patients were classified for grade I in Mallampati score and 45% of patients- grade II in this scale. At least 50% reduction of RDI after UPPP was observed in 75% of patients. The mean RDI was decreased from 21,35 in preoperative period to 9,85 in the control study. In 60% of our patients the RDI dropped to the value of less then 10. In 5% of the patients, the surgical treatment did not decrease at least 50% of RDI. However in this patient group, we observed a slight improvement of mean minimal saturation (from 84,1 +/- 3,8 to 86,2% +/- 3,6)., Conclusion: Using simple clinical parameters for preliminary selection of patients with mild and moderate OSA enabled us to achieve considerably better success rate after UPPP.

Introduction: The treatment of snoring and obstructive sleep apnea syndrome comprises preventive behavior, conservative methods (CPAP) and surgical treatment. In the diagnostics procedures the most important aim is to determinate whether the patient is an habitual snorer or OSA patient. Very important thing is also patient's qualification for proper mode of treatment. The aim of the surgical treatment is to remove all the reasons that obturate the upper airways and cause the increasing of respiratory air stream resistance. The most collapsible airway region during sleep is oropharynx involves the soft palate, uvula, tonsils, tonsillar pillars, base of the tongue and pharyngeal muscles., Material and Methods: In the study the results of surgical treatment of 138 patients suffer from breathing disturbances during sleep treated at the ENT Department Silesian Medical University in Zabrze in the years 1997 to 2002 were presented. In the evaluated group were 51 habitual snorer and 87 OSA patients. Various type of surgical procedures were performed depend on the airway obturation level (septoplasty, tonsillectomy, LAUP, arytenoidectomy). The postoperative control sleep studies were performed in 68 patients (49.3%) 6 to 12 weeks after the end of the surgical treatment. In all the patients the subjective improvement were evaluated., Results: In 35 from 45 OSA patients (77.8%) RDI decreased after the surgical treatment more then 50% of the preoperative value or was lower then 10 (RDI lower then 10 was in 16 patients, in 19 patients decreased more than 50%). The subjective radical improvement was obtained in 107 patients (77.5%), moderate improvement in 19 cases (13.8%) and no improvement in 12 patients (8.7%)., Conclusions: On the base of our results we concluded that surgery is successful method for treatment of selected patients with breathing disturbances during sleep.

In the years 1996-1999 in the Department of Otolaryngology of Medical Academy in Warsaw 58 patients with respiratory disorders during sleep were treated using uvulopalatoplasty in 35 cases and laser uvulopalatoplasty in 23 cases. The authors describes operation technique, qualification criteria and results assessed on the basis of basic values of polysomnographic study as well as subjective feelings of patients.

Laser Assisted Uvulopalatoplasty (LAUP) the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome was first performed by Kamami in 1988. LAUP can reduce the airway obstruction in the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. From 1998 to 2000 37 patients underwent LAUP in our ENT Department in Zabrze. This group comprised of 19 OSA patients and 18 habitual snorers. In cases of nasal obstruction by turbinate hypertrophy or septal deviation we performed septoplasty or partial inferior turbinectomy by laser CO2. In some cases with palatin or lingual tonsils hypertrophy we also performed tonsillectomy or lingual tonsil laser ablation. In 5 patients LAUP was performed in several stages. Before and after the surgical treatment each patient were evaluated by PolyMESAM--the device belongs to the third diagnostic level. In all postoperative evaluated OSA patients the RDI decreased significantly. In 4 patients (50% of evaluated after LAUP patients) the RDI dropped to 10 or lower. Snoring was eliminated or significantly reduced in 83% of patients classified as the habitual snorers. No serious complications were observed. LAUP is a good alternative to UPPP in the surgical treatment of habitual snorers and some of the patients with OSA syndrome.