Obstructive sleep apnea in adult ambulatory anesthesia: navigating guidelines and evidence for safe home discharge

Preoperative assessment to predict postprocedural complications is based on obstructive sleep apnea (OSA) status and severity, coexisting cardiorespiratory disease severity, expected physiologic impacts of anesthesia and surgery, and anticipated opioid requirements.

Patients with moderate or severe OSA are more likely ambulatory candidates if the procedure is peripheral or superficial, under local or RA, and postoperative pain is mainly managed with nonopioid analgesia.

OSA patients undergoing sedation may be at increased postoperative risk if long-acting sedatives are used and monitored recovery time is inadequate.

Regardless of the procedure, a comprehensive PACU assessment strategy is essential.

Before discharge, patients must be free of postoperative cardiorespiratory indicators of OSA-related complications, have pain managed with at most low-dose oral opioids, and maintain adequate oxygen saturation on room air.

Patients who fail to meet these standards should not be discharged and should stay in a monitored environment overnight.