Effects of OSA, inhalational anesthesia, and fentanyl  on the airway and ventilation of children

P Pu ur rp po os se e: : To determine, in a subset of children previously reported, if the time of day when adenotonsillectomy for severe obstructive sleep apnea syndrome (OSAS) was performed affected the incidence of postoperative respiratory complications.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : Children having adenotonsillectomy were included if they had a polysomnographic diagnosis of severe OSAS within six months prior to operation. Patients who met the inclusion criteria were grouped by the occurrence of postoperative desaturation into a saturated (SAT) and desaturated (deSAT) group. The charts of children in group deSAT were reviewed. The clock time of the surgical procedure was recorded and categorized as morning (AM) or afternoon (PM).R Re es su ul lt ts s: : Eighty-eight patients met the inclusion criteria. There were 31 girls and 57 boys. The mean ± SD age (yr) and weight (kg) were 4.6 ± 2.9 yr and 20.8 ± 14.5 kg respectively. There were 63 children in the SAT group and 25 in the deSAT group. Differences in age, weight and gender were not significant. The preoperative oxygen saturation (SaO 2 ) nadir for the SAT and deSAT groups was 80.8 ± 10.2% and 67.6 ± 17.5% (P < 0.05) respectively. The preoperative obstructive apnea and hypopnea index was 15.8 ± 10.2 and 35.7 ± 34.6 events·hr -1 (P < 0.05), respectively. Surgery in 63 (71.6%) children was performed in the AM. Univariate logistic regression identified PM surgery [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.7 to 12.6, P = 0.002] and a preoperative SaO 2 nadir < 80% (OR 3.6, 95% CI 1.4 to 9.4, P = 0.009) as risk factors predicting postadenotonsillectomy desaturation.C Co on nc cl lu us si io on n: : Children with severe OSAS whose surgery is performed in the AM are less likely to desaturate following adenotonsillectomy than children whose surgery is performed in the PM. 80,8 ± 10,2 % et de 67,6 ± 17,5 % (P < 0,05) de 15,8 ± 10,2 et de 35,7 ± 34,6 événements·h -1 (P < 0,05), respectivement. L'opération de 63 (71,6 %) Éléments cliniques : Des enfants subissant une amygdalectomie ont été inclus dans notre étude si un diagnostic polysomnographique de SAOS sévère avait été établi dans les six mois avant l'opération. Les patients admis ont été répartis selon l'occurrence de désaturation postopératoire dans un groupe de saturation (SAT) ou de désaturation (deSAT). Les dossiers des enfants du groupe deSAT ont été révisés. L'heure de l'opération a été notée sous matin (AM) ou après-midi (PM). Résultats dans les groupes SAT et deSAT respectivement. Les indices d'apnée obstructive et d'hypopnée préopératoires étaient

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“…21 It is noteworthy that the majority of desaturation (72%) occurred during sleep. Pediatric OSAS is a disease of rapid eye movement (REM) sleep.…”

Section: Time Of Day Of Surgerymentioning

confidence: 99%

Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon

Koomson

Morin

Brouillette

et al. 2004

Can J Anesth/J Can Anesth

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“…In support of this notion are reports that children with OSA have reduced spontaneous ventilation and elevated CO 2 in the presence of inhalational anesthesia compared with control subjects. Furthermore, opioid analgesics appear to cause an increase in central apnea in a majority of OSA subjects [19].…”

Section: Osa Parametermentioning

confidence: 99%

Age specific differences in pediatric obstructive sleep apnea

Don

Geller

Koempel

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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“…Children with OSA who receive a standard dose of opioid during anaesthesia exhibit more apnoea than expected [10].…”

Section: Risk Stratification Of Children With Osamentioning

confidence: 83%

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2017

JOENTR

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Obstructive Sleep Apnoea (OSA) in children is a common condition, diagnosed and managed by various medical professionals including general practitioners, paediatricians and general and paediatric otolaryngologists. If not investigated and treated early, it carries significant long-term consequences such as poor growth, failure to thrive, attention-deficit disorder, behavioural problems, poor academic performance and cardiopulmonary disease. The most common etiology is adenotonsillar hypertrophy, for which adenotonsillectomy is currently the mainstay of treatment. This article aims to raise awareness of the definition of OSA, presentation and methods of investigation of children with OSA and risk stratification in such children owing to high risk of perioperative and postoperative complications following adenotonsillectomy. We discuss current clinical guidelines including our own departmental guidelines, at a United Kingdom (UK) District General Hospital (DGH), as an example in risk stratification of children with OSA in view of adenotonsillectomy in order to improve service and optimise patient safety.

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Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children

Cited by 136 publications

References 27 publications

Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon

Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon

Age specific differences in pediatric obstructive sleep apnea

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