Drug-induced sleep endoscopy

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
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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

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

Postoperative management

Disposition

Typically home

Pain management

Minimal