Difference between revisions of "Drug-induced sleep endoscopy"

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{{Infobox surgical procedure
{{Infobox surgical procedure
| anesthesia_type = MAC
| anesthesia_type = MAC
| airway = Natural airway
| airway = Natural airway (CPAP machine)
| lines_access = 1 PIV
| lines_access = 1 PIV
| monitors = Standard ASA
| monitors = Standard ASA
Line 9: Line 9:
}}
}}


For patients with obstructive sleep apnea (OSA), a specialist can use an endoscope to view the upper airway as a patient is put under anesthesia to observe airway obstruction.
A drug-induced sleep endoscopy (DISE) is performed for patients with obstructive sleep apnea (OSA), whereby a specialist can use an endoscope to view the upper airway as the patient is put under anesthesia to observe airway obstruction.


== Overview ==
== Overview ==
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=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===
=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===
CPAP machine is placed on patient. As the patient is slowly sedated, an endoscope is inserted into CPAP after the patient is sedated to observe dynamic airway behavior.


== Preoperative management ==
== Preoperative management ==
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|-
|-
|Cardiovascular
|Cardiovascular
|
|Watch for pulm HTN
|-
|-
|Pulmonary
|Pulmonary
|
|Watch for sequelae of chronic OSA
|-
|-
|Gastrointestinal
|Gastrointestinal
Line 55: Line 56:


=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
N/A


=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
Propofol infusion, propofol boluses, nasal cannula


=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
N/A


=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
N/A


== Intraoperative management ==
== Intraoperative management ==


=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
Standard ASA monitors


=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
* CPAP machine by surgeons
*Propofol ~20 mg bolus


=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
Supine


=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
* Propofol TIVA
** Initial bolus of 20 mg
**Start infusion typically around 125 mcg/kg/min
** Give 10 mg every 2 minutes and/or increase infusion by 25 mcg/kg/min


=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
Typically home


=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
Minimal


=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}


== References ==
== References ==


[[Category:Surgical procedures]]
[[Category:Surgical procedures]]

Latest revision as of 14:05, 14 April 2025

Drug-induced sleep endoscopy
Anesthesia type

MAC

Airway

Natural airway (CPAP machine)

Lines and access

1 PIV

Monitors

Standard ASA

Primary anesthetic considerations
Preoperative

Patients with OSA usually obese and may have sequelae

Intraoperative

Slowly induce anesthesia as surgeons watch airway collapse on endoscope

Postoperative
Article quality
Editor rating
In development
User likes
0

A drug-induced sleep endoscopy (DISE) is performed for patients with obstructive sleep apnea (OSA), whereby a specialist can use an endoscope to view the upper airway as the patient is put under anesthesia to observe airway obstruction.

Overview

Indications

Obstructive sleep apnea (OSA)

Surgical procedure

CPAP machine is placed on patient. As the patient is slowly sedated, an endoscope is inserted into CPAP after the patient is sedated to observe dynamic airway behavior.

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic
Cardiovascular Watch for pulm HTN
Pulmonary Watch for sequelae of chronic OSA
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

N/A

Operating room setup

Propofol infusion, propofol boluses, nasal cannula

Patient preparation and premedication

N/A

Regional and neuraxial techniques

N/A

Intraoperative management

Monitoring and access

Standard ASA monitors

Induction and airway management

  • CPAP machine by surgeons
  • Propofol ~20 mg bolus

Positioning

Supine

Maintenance and surgical considerations

  • Propofol TIVA
    • Initial bolus of 20 mg
    • Start infusion typically around 125 mcg/kg/min
    • Give 10 mg every 2 minutes and/or increase infusion by 25 mcg/kg/min

Emergence

Postoperative management

Disposition

Typically home

Pain management

Minimal

Potential complications

References

Top contributors: Tony Wang

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