Safety of restarting continuous positive airway pressure (CPAP) therapy following endoscopic endonasal skull base surgery

作     者：Mark B.Chaskes Mindy R.Rabinowitz Mark B. Chaskes;Mindy R. Rabinowitz

作者机构：Department of OtolaryngologyHead and Neck SurgeryThomas Jefferson University HospitalPhiladelphiaUSA 

出 版 物：《World Journal of Otorhinolaryngology-Head and Neck Surgery》 (世界耳鼻咽喉头颈外科杂志（英文）)

年 卷 期：2022年第8卷第1期

页      面：61-65页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Continuous positive airway pressure Endoscopic skull base surgery Obstructive sleep apnea Transsphenoidal surgery 

摘      要：Objectives:Patients with obstructive sleep apnea(OSA)are at increased risk of perioperative and postoperative *** use of continuous positive airway pressure(CPAP)in the perioperative period may be of potential ***,among patients who have undergone endonasal skull base surgery,many surgeons avoid prompt re-initiation of CPAP therapy due to the theoretical increased risk of epistaxis,excessive dryness,pneumocephalus,repair migration,intracranial introduction of bacteria,and cerebrospinal fluid(CSF)*** objective of this article is to review the most up-to-date literature regarding when it is safe to resume CPAP usage in the patient undergoing endonasal skull base *** Sources and Methods:This review combines the most recent literature as queried through PubMed regarding the safety of CPAP resumption following endonasal skull base ***:Recent surveys of skull base surgeons demonstrate little consensus regarding the post-operative management of *** cadaveric studies suggest that approximately 85%of delivered CPAP pressures are transmitted to the sphenoid ***,at frequently prescribed CPAP pressure settings,common sellar reconstruction techniques maintain their integrity while preventing very little transmission of pressure into the *** small retrospective case series,patients with OSA who received CPAP immediately following transsphenoidal pituitary surgery had similar rates of surgical complications as OSA patients who did not receive CPAP in the immediate post-operative *** of reinitiating CPAP too early,such as the development of pneumocephalus,rarely ***:There remains a paucity of objective data regarding when it is safe to resume CPAP following endonasal skull base *** cadaveric studies and small retrospective case series suggest that it may be safe to resume CPAP earlier than is often practiced following endonasal skull base surgery.