Postoperative Care

Patient Positioning and Monitoring

For patients with obstructive sleep apnea, the American Society of Anesthesiologists (ASA) recommends maintaining a lateral, semiupright, or other nonsupine position to reduce the risk of respiratory compromise 1
The Anaesthesia society suggests considering capnography for early detection of airway obstruction in patients with obstructive sleep apnea or at risk of respiratory compromise, with a strength of evidence based on expert opinion 2
The American Society of Anesthesiologists recommends positioning the patient in a semi-sitting or head-elevated position to improve oxygenation and prevent atelectasis development 2
Obese patients or those with sleep apnea should be maintained in a semi-sitting position and closely monitored for oxygenation, according to the World Journal of Emergency Surgery 3
Patients with hypoxemia should be considered for non-invasive positive pressure ventilation (CPAP or NIPPV) if hiccups are associated with oxygen desaturation, as suggested by the European Respiratory Society 4

The ASA recommends chlorpromazine 25-50 mg orally or intramuscularly every 6-8 hours as the first-line pharmacological treatment for persistent postoperative hiccups, with a moderate strength of evidence based on clinical trials 1
Avoid continuous background infusions of opioids in patients with obstructive sleep apnea and hiccups, as this increases the risk of respiratory depression, according to the ASA guidelines with a high strength of evidence based on clinical studies 1
Chlorpromazine may cause hypotension, particularly in elderly patients, and should be administered with caution, with a high strength of evidence based on clinical trials 1

If hiccups persist beyond 48 hours, a complete diagnostic evaluation should be performed to identify underlying causes, with a moderate strength of evidence based on expert opinion 2
Consider specialist consultation if hiccups persist beyond 72 hours, with a low strength of evidence based on expert opinion 2
The World Journal of Emergency Surgery suggests evaluating the need for venous thromboembolism prophylaxis in patients with persistent hiccups that limit mobility 3

Persistent hiccups may sometimes indicate serious underlying conditions such as pulmonary embolism or cardiac disease, with a moderate strength of evidence based on clinical studies 2
The World Journal of Emergency Surgery recommends considering alternative therapies, such as acupuncture, for patients with persistent hiccups, although no citation is provided