Opioids and sedatives worsen obstruction post-op. Plan difficult airway, ramped position, and extended PACU monitoring for moderate/severe OSA.
Screening
- STOP-BANG or local questionnaire
- Known CPAP: bring device for inpatient use
- Comorbidities: HTN, pulmonary hypertension
Airway and ventilation
- Ramped head-up, preoxygenate well
- Expect reduced FRC and fast desaturation
- Lower opioid doses, multimodal analgesia
- Regional techniques when suitable
Low risk (STOP-BANG 0 to 2)
- Standard care
- Multimodal analgesia
- Routine recovery
Intermediate (3 to 4)
- Ramped position, preoxygenate
- Minimise opioids
- Extended PACU monitoring
High risk (5 to 8) or known OSA
- Difficult airway plan
- Bring and use CPAP device
- Oximetry monitoring if inpatient
Perioperative plan
1
1. Pre-op
Anaesthetic review for BMI >40 or OSA. CPAP settings documented.
Anaesthetic review for BMI >40 or OSA. CPAP settings documented.
↓
2
2. Induction
Experienced operator, backup airway. Reverse Trendelenburg or head-up.
Experienced operator, backup airway. Reverse Trendelenburg or head-up.
↓
3
3. Emergence
Fully awake extubation. Sit upright early in PACU.
Fully awake extubation. Sit upright early in PACU.
↓
4
4. Post-op
CPAP when sleepy. Oximetry monitoring if inpatient. Avoid PRN opioid stacking.
CPAP when sleepy. Oximetry monitoring if inpatient. Avoid PRN opioid stacking.
Pregnancy and bariatrics
- Earlier anaesthetic involvement
- Blood pressure cuff size, difficult access
Pitfalls
- Supine induction in severe obesity
- Discharging after opioids without OSA plan
MedPrep - www.medprep.uk - Educational revision aid only. Not clinical guidance. Doses are adult examples; check the BNF, current guidelines and local policy, and seek senior advice. Nov 2026