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Scoring System

 

The ASA practice guidelines [10] offer a scoring system (Table 2) that can be useful to estimate whether a patient is at increased perioperative risk of complications from OSA. This is shown below.

Download Table 2 as a PDF document.

 

Table 2. OSA Scoring System: Example

A. Severity of sleep apnea based on sleep study (or clinical indicators if sleep study not available).
Point score ____ (0‑3)*†		 Points
Severity of OSA (see Table 1):
None 0
Mild 1
Moderate 2
Severe 3
 
 
B. Invasiveness of surgery and anesthesia.
Point score _____ (0‑3)
Type of surgery and anesthesia:
Superficial surgery under local or peripheral nerve block anesthesia without sedation 0
Superficial surgery with moderate sedation or general anesthesia 1
Peripheral surgery with spinal or epidural anesthesia (with no more than moderate sedation) 1
Peripheral surgery with general anesthesia 2
Airway surgery with moderate sedation 2
Major surgery, general anesthesia 3
Airway surgery, general anesthesia 3
 
 
C. Requirement for postoperative opioids.
Point score _____ (0‑3)
Opioid requirement:
None 0
Low-dose oral opioids 1
High-dose opioids, parenteral or neuraxial opioids 3
 
 
D. Estimation of perioperative risk. Overall score = the score for A plus the greater of the score for either B or C.
Point score _____ (0‑6)‡

A scoring system similar to this table may be used to estimate whether a patient is at increased Perioperative risk of complications from obstructive sleep apnea (OSA). This example, which has not been clinically validated, is meant only as a guide, and clinical judgment should be used to assess the risk of an individual patient.

* One point may be subtracted if a patient has been on continuous positive airway pressure (CPAP) or noninvasive positive-pressure ventilation (NIPPV) before surgery and will be using his or her appliance consistently during the postoperative period.

† One point should be added if a patient with mild or moderate OSA also has a resting arterial carbon dioxide tension (Paco2) greater than 50 mmHg.

‡ Patients with score of 4 may be at increased perioperative risk from OSA; patients with a score of 5 or 6 may be at significantly increased perioperative risk from OSA.

 

Source: Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Cote CJ, Nickinovich DG, Prachand V, Ward DS, Weaver EM, Ydens L, Yu S; American Society of Anesthesiologists Task Force on Perioperative Management. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2006; 104: 1081-1093

 

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