Drug-induced sleep endoscopy

Drug-induced sleep endoscopy

Anesthesia type	MAC
Airway	Natural airway (nasal cannula)
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
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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

Endoscope is inserted 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

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

• Nasal cannula

Positioning

Supine

Maintenance and surgical considerations

• Propofol infusion
  • Typically start around 125 mcg/kg/min
  • Increase by 25 mcg/kg/min every 2-3 minutes

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications