J Dent Anesth Pain Med.  2017 Mar;17(1):71-76. 10.17245/jdapm.2017.17.1.71.

Anesthetic management for simultaneous drug-induced sleep endoscopy and maxillomandibular advancement in a patient with obstructive sleep apnea

• Kuk TS
• So E
• Karm MH
• Kim J
• Chi SI
• Kim HJ
• Seo KS
• On SW
• Choi JY

• KMID: 2374727
• DOI: http://doi.org/10.17245/jdapm.2017.17.1.71

Abstract

Drug-induced sleep endoscopy (DISE) is used to identify areas of upper airway obstruction, which occurs when patients with obstructive sleep apnea (OSA) snore. DISE enables effective diagnosis and appropriate treatment of the obstruction site. Among surgical treatment methods for OSA, maxillomandibular advancement surgery (MMA) is performed to move a jaw forward; the surgery has a high success rate for OSA treatment. In DISE, anesthetics such as propofol and midazolam must be administered to induce snoring while the patient is deeply sedated for an accurate diagnosis to be made. When inducing deep sedation in a patient with OSA, airway obstruction may increase, causing oxygen saturation to drop; airway interventions are necessary in such cases. Effective DISE and MMA surgery can be performed by administering propofol through target-controlled infusion while monitoring the bispectral index (BIS).

Keyword

Drug Induced Sleep Endoscopy; Obstructive Sleep Apnea; Propofol

MeSH Terms

Airway Obstruction
Anesthetics
Deep Sedation
Diagnosis
Endoscopy*
Humans
Jaw
Midazolam
Oxygen
Propofol
Sleep Apnea, Obstructive*
Snoring
Anesthetics
Midazolam
Oxygen
Propofol

Figure

• 

  Fig. 1 A nasal cannula was placed in the patient's mouth to supply oxygen. Drug-induced sleep endoscopy (DISE) was performed simultaneously with capnography monitoring.

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  Fig. 2 Propofol was infused at an effect-site concentration (red line) controlled through target-controlled infusion. The bispectral index (BIS) decreased according to changes in the effect-size concentration of propofol.

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