Preoperably:
- history and physical to assess comorbid conditions
- limited use of sedatives: because increases sensitivity in obstructive sleep apnea
- ketamine
- Sodium citrate
- Metoclopramide
- airway exam, because possible difficult airway
Intraoperatively:
- Preoxygenation: prone to desaturation because decrease FRC
- if the airway is difficult, have the difficult airway card in the room , for an awake intubation
- Multimodal pain management
- IV NSAIDS
- IV Tylenol
- Rectus Sheath block
- Local wound infiltration
Monitors
- Standard American Society of Anesthesiologists monitors
- pulse oximeter
- 5 lead EKG
- Non invasive blood pressure
- Temperature probe
- Capnograft
- Foley catheter
- Intravenous access is difficult, would place a centerline
Postoperatively:
- Extubate in the head of position to improve pulmonary mechanics an extubate only after the patient is fully awake.
- Have a CPAP machine in the post anesthesia care unit and continue to monitor the patient close in the PACU for any episodes of apnea and desaturation
