An updated review of pediatric drug‐induced sleep endoscopy

Wilcox, Lyndy J.; Bergeron, Mathieu; Reghunathan, Saranya; Ishman, Stacey L.

doi:10.1002/lio2.118

Cited by 90 publications

(71 citation statements)

References 79 publications

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“…In addition, drug‐induced sleep endoscopy (DISE) has not been studied in this population. However, given the complexity of these patients, DISE might be useful to provide information about the site(s) of obstruction and to tailor surgery for the specific site(s) of obstruction . Moreover, parents would ideally be involved in the decision making regarding the optimal medical or surgical management of sleep disorders .…”

Section: Discussionmentioning

confidence: 99%

“…However, given the complexity of these patients, DISE might be useful to provide information about the site(s) of obstruction and to tailor surgery for the specific site(s) of obstruction. 78 Moreover, parents would ideally be involved in the decision making regarding the optimal medical or surgical management of sleep disorders. 79,80 Finally, OSA should not be overlooked in this population because treatment has proven to improve patient and family quality of life in both typical children and those with syndromes; the same conclusion could reasonably be extrapolated to this population.…”

Section: Sleep Disordersmentioning

confidence: 99%

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Cornelia de lange manifestations in otolaryngology: A systematic review and meta‐analysis

2019

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Objectives Cornelia de Lange syndrome (CdLS) is a rare genetic disorder. Our goal was to systematically review the literature regarding otolaryngology manifestations of CdLS. Methods We systematically reviewed the PubMed, Embase, CINAHL, Scopus, and Google Scholar databases for original articles of otolaryngology manifestations for patients with CdLS. These articles were analyzed, and pooled prevalence was calculated. Results We analyzed 1,310 patients included in 35 case series and 34 case reports. Hearing loss was present for many patients (27 studies), with sensorineural hearing loss affecting 40.3% (95% confidence interval [CI]: 17.3–63.4) and conductive affecting 22.7% (95% CI: 5.7–39.7). Recurrent acute otitis media was the most frequent infectious manifestation, with 56.5% (95% CI: 34.1–78.4) in seven studies, followed by recurrent airway infections with 44.1% (95% CI: 11.0–87.1) in five studies. Forty‐nine (49.7%) percent of patients (95% CI: 25.9–73.6) in nine studies had dysphagia, and 76.6% (95% CI: 59.8–93.3) in four studies had some degree of dysphonia. Craniofacial anomalies were reported in 30 studies, with micrognathia (53.1%; 95% CI: 34.1–72.1) and high arched palate (70.6%; 95% CI: 56.5–84.8) commonly reported. Additional physical exam abnormalities reported included those involving: lips (76.8%; 95% CI: 65.3–88.4), dentition (65.1%; 95% CI: 27.2–100), mouth (85.5%; 95% CI: 76.2–93.8), and eyelashes (87.1%; 95% CI: 77.2–96.9). Sleep‐disordered breathing or obstructive sleep apnea affected 25.8% (95% CI: 11.4–40.2) of patients (7 studies). Airway anomalies were reported in 11 case reports. Conclusion This is the first comprehensive evaluation of otolaryngologic manifestations in the CdLS literature. Most reported hearing loss and craniofacial anomalies. Sleep disorders occurred in a minority of patients, whereas airway disorders were primarily reported in case reports. These conditions should be further examined given their potential life‐threatening implications. Level of Evidence 3a Laryngoscope, 130:E122–E133, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Sleep Disordersmentioning

confidence: 99%

Cornelia de lange manifestations in otolaryngology: A systematic review and meta‐analysis

2019

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“…Currently, there is a lack of consensus between experts regarding the anesthetic protocol, management decisions, and scoring system for pediatric DISE . However, as DISE findings can provide the type and degree of airway obstruction in the clinical setting, it has a role in the preoperative evaluation of patients with OSA who are at risk of multiple levels airway obstruction …”

Section: Future Osa Assessment Toolsmentioning

confidence: 99%

Preoperative identification of children at high risk of obstructive sleep apnea

Ohn

Eastwood

Ungern‐Sternberg

2020

Pediatric Anesthesia

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Obstructive sleep apnea is a common childhood disorder which can lead to serious health problems if left untreated. Enlarged adenoid and tonsils are the commonest causes, and adenotonsillectomy is the recommended first line of treatment. Obstructive sleep apnea poses as an anesthetic challenge, and it is a well‐known risk factor for perioperative adverse events. The presence and severity of an obstructive sleep apnea diagnosis will influence anesthesia, pain management, and level of monitoring in recovery period. Preoperative obstructive sleep apnea assessment is necessary, and anesthetists are ideally placed to do so. Currently, there is no standardized approach to the best method of preoperative screening for obstructive sleep apnea. Focused history, clinical assessments, and knowledge regarding the strengths and limitations of available obstructive sleep apnea assessment tools will help recognize a child with obstructive sleep apnea in the preoperative setting.

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“…Propofol infusions, coupled with short‐acting narcotics (remifentanil or alfentanil), are commonly used . Dexmedetomidine and ketamine have been described in pediatric drug‐induced sleep endoscopy (DISE), which requires maintenance of spontaneous respiration at varying anesthetic depths . The combination of propofol, dexmedetomidine, and ketamine, with topical local anesthetic, may be particularly useful for maintaining good quality spontaneous respiration.…”

Section: Anesthetic Techniquesmentioning

confidence: 99%

Anesthesia for shared airway surgery in children

Bradley

Lee

Peyton

2020

Pediatric Anesthesia

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Shared airway surgery in children is a complex, high‐risk undertaking that requires continuous communication and cooperation between the anesthetic and surgical teams. Airway abnormalities commonly seen in children, the surgical options, and the anesthetic techniques that can be used to care for this vulnerable population are discussed. Many of these procedures were traditionally carried out using jet ventilation, or intermittent tracheal intubation, but increasingly spontaneously breathing “tubeless” techniques are being used. This review has been written from both the surgical and anesthetic perspective, highlighting the concerns that both specialties have in relation to the maintenance of surgical access and operating conditions, and the need for the provision of anesthesia, oxygenation, and ventilation where the airway is the primary site of operation.

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An updated review of pediatric drug‐induced sleep endoscopy

Cited by 90 publications

References 79 publications

Cornelia de lange manifestations in otolaryngology: A systematic review and meta‐analysis

Cornelia de lange manifestations in otolaryngology: A systematic review and meta‐analysis

Preoperative identification of children at high risk of obstructive sleep apnea

Anesthesia for shared airway surgery in children

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