X Uvulopalatopharyngoplasty
Uvulopalatopharyngoplasty is performed primarily for the treatment of OSA. Tonsillectomy is often performed concurrently. Nasopharyngeal airway obstruction is relieved by removing redundant and obstructing tissues of the posterior pharynx.
Inspiratory muscle tone is lost during rapid eye movement sleep, resulting in relaxation of the pharyngeal muscles and thus creating airway obstruction. Adults with OSA are often obese.
2. Preoperative assessment
a) History and physical examination
(1) Cardiac: Hypoxia and hypercapnia may lead to pulmonary hypertension, right ventricular hypertrophy, cor pulmonale, cardiac arrhythmias, and failure of the right side of the heart.
(2) Respiratory: Frequent nocturnal arousals (up to 50 times per hour) are common. Periods of apnea may last up to 2 to 3 minutes. These patients often have a long history of snoring.
(3) Neurologic: Loss of rapid eye movement sleep results in excess daytime somnolence, fatigue, and impaired judgment.
b) Patient preparation: Medical management includes weight reduction in obese patients, decreasing alcohol consumption, and nasal continuous positive airway pressure.
(1) Laboratory tests: As indicated by the history and physical examination. These patients often develop polycythemia from chronic hypoxemia.
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