Overview

Spinal Morphine for Patients With Obstructive Sleep Apnea

Status:
Suspended

Trial end date:
2020-08-01

Target enrollment:
0

Participant gender:
All

Summary

Patients with Obstructive Sleep Apnea (OSA) appear to be especially vulnerable to medications that suppress pharyngeal muscle activity such as general anesthetics and opioids. Opioids can depress the ventilator response to airway obstruction and inhibit the awakening response to hypoxia and hypercarbia, resulting in central respiratory depression. OSA is therefore an important risk factor for serious postoperative complications, including perioperative death. While OSA is increasingly recognized as a serious perioperative concern, current clinical practices are highly inconsistent with regard to the management of surgical patients with OSA. Additionally, the relative safety of intrathecal opioids in this patient population remains unknown.

Phase:

N/A

Accepts Healthy Volunteers?

Details

Lead Sponsor:

University Health Network, Toronto

Treatments:

Morphine

Criteria

Inclusion Criteria:

1. Adults, aged 18-85

2. ASA physical status I-III

3. Suspected of having Obstructive Sleep Apnea(OSA) or previously diagnosed with OSA

4. Scheduled to undergo elective primary Total Hip or Knee Arthroplasty

Exclusion Criteria:

1. Chronic obstructive pulmonary disease

2. Asthma

3. History of congestive heart failure

4. Valvular disease

5. Dilated cardiomyopathy

6. Implanted pacemaker or defibrillator

7. Diagnosed OSA who are undergoing continuous positive airway pressure (CPAP) treatment

8. Contraindications to spinal anesthesia

9. Contraindications to a component of multi-modal analgesia

10. Local anesthetic allergy

11. Anticipated surgical duration > 2.5hrs

12. Opioid tolerance (>250mg/24hr oral morphine equivalent pre-operatively)

13. Pregnancy

14. History of significant cognitive or psychiatric condition that may affect patient
assessment, or

15. Inability to provide informed consent.

16. Participation in other clinical studies