Abstract
ObjectiveTo evaluate the post-operative outcomes of patients with obstructive sleep apnea (OSA) given intraoperative ketamine.Design: case-control studyA total of 574 patients (287 received ketamine and 287 were matched controls) diagnosed with OSA and body mass index (BMI) > 30 who received general anesthesia were included in this study. Patients given intraoperative ketamine were matched (1:1) with those who did not receive ketamine for age, gender, BMI, ethnicity, anesthesia time, intraoperative fentanyl dose, ketamine dose, and surgery type. A sub-analysis was performed based on the dose of ketamine administered and also on the surgery type. Measured outcomes include post-operative pain scores, post-operative opioid requirements, respiratory status, oxygen use, and duration post-operatively.ResultsIntraoperative ketamine use did not decrease pain scores or post-operative opioid use when compared with the control (no intraoperative ketamine) group. Patients who received high-dose ketamine had significantly higher post-operative pain scores (p=0.048) while in the post-anesthesia care unit (PACU) and required supplemental oxygen for a longer period of time (p = 0.030), pain scores were not significant for patients who underwent orthopedic/spine procedures (p = 0.074), and high-dose ketamine group patients who underwent orthopedic/spine surgery required significantly more opioids in the PACU (p = 0.031). Among patients who received low-dose ketamine, those who underwent head, ear, nose, and throat surgery required significantly more opioids in PACU (p = 0.022).ConclusionsLow-dose intraoperative ketamine did not decrease pain scores or post-operative opioid use significantly and did not improve standard respiratory recovery parameters for OSA patients after surgery. Neither low- nor high-dose ketamine demonstrated the anticipated benefits of low pain scores and reduced post-operative opioid use. These outcomes will differ depending on the surgery type and dose of ketamine used.
Highlights
Obstructive sleep apnea (OSA) affects up to 25% of elective surgical patients [1], many of whom are undiagnosed
Intraoperative ketamine use did not decrease pain scores or post-operative opioid use when compared with the control group
Neither lownor high-dose ketamine demonstrated the anticipated benefits of low pain scores and reduced postoperative opioid use
Summary
Obstructive sleep apnea (OSA) affects up to 25% of elective surgical patients [1], many of whom are undiagnosed. The STOP-Bang questionnaire is used to screen patients for the probability of OSA [3]. Some of the difficulties encountered in these patients include difficult mask ventilation secondary to redundant soft tissue, decreased respiratory reserve leading to rapid desaturation, blood sugar issues secondary to diabetes, and uncontrolled hypertension, to name a few [5,6,7]. An additional hurdle includes post-operative pain management, as OSA patients demonstrate decreased pain tolerance postoperatively. This decreased pain tolerance, combined with baseline hypopnea and increased sensitivity to respiratory depression by opioids, makes their post-operative course especially dangerous and complicated [8,9]
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