OPERATIVE NOTE

Date of Surgery: @ORDATE@

Surgeon/Attending: William G. Morrel, MD

Pre-op Diagnosis: Obstructive Sleep Apnea (G47.33) with CPAP intolerance

Post-op Diagnosis: Obstructive Sleep Apnea (G47.33) with CPAP intolerance

Procedure(s):
Drug induced sleep endoscopy (DISE) with flexible nasopharyngoscopy/laryngoscopy

Indications: The patient is a @AGE@ @SEX@ with a history of  moderate to severe symptomatic obstructive sleep apnea, who is intolerant and unable to achieve benefit with positive pressure therapy.  The patient presents today for drug-induced sleep endoscopy to better characterize the locations and patterns of obstruction and to predict appropriate medical and/or surgical options moving forward.  

Anesthesia: MAC

Operative Findings: Significant AP collapse at the level of the velum. There was no evidence of complete concentric palatal obstruction. Good movement of tongue base with jaw thrust. The patient does appear to be a candidate anatomically for hypoglossal nerve stimulation therapy.  No abnormal nasopharyngeal/laryngeal/hypopharyngeal lesions noted.

Procedure Description: The patient was brought to the operating room and was anesthetized via the standard drug-induced sleep endoscopy protocol. A 10 mg propofol bolus was given and then the propofol infusion was started at 100 mcg/kg/min and gradually increased to until conditions that mimic sleep were gradually observed: the patient was not responsive to verbal commands, but still with spontaneous respirations when sleep disordered breathing events and associated desaturations were clearly observed.

Under these conditions, the flexible endoscope was inserted into the right nasal cavity to examine the nasopharynx, oropharynx, and larynx/hypopharynx. A small amount of topical 2% lidocaine jelly was used in the nose. The VOTE score at baseline was complete velum AP collapse (no significant concentric collapse noted), complete AP oropharynx collapse, partial tongue base AP collapse, no significant epiglottis collapse. With simulated jaw advancement and tongue advancement, the hypopharyngeal  obstruction and secondarily the palatal collapse also improved. 

In summary, there was no evidence of complete concentric palatal obstruction and the patient does appear to be a candidate anatomically for hypoglossal nerve stimulation therapy. 

Estimated Blood Loss: 0 cc

Complications: {NONE:21267}

Specimens: None

Implants: None

Surgeon Notes: I was present for and performed the entire procedure.  

@ME@ 
Date: @TD@  Time: @NOW@