Episodic Complete Airway Obstruction in Children with Undiagnosed Obstructive Sleep Apnea

Obstructive sleep apnoea syndrome in children

“…Children with long-standing OSA syndrome who become chronically hypoxaemic and hypercarbic may develop acute respiratory failure and right ventricular failure [8]. These children may present acutely, with lifethreatening upper airway obstruction, following pharyngeal infection or due to excessive sedation following anaesthesia [39][40][41].…”

“…Close communication between all medical staff involved in their care is fundamental to the well-being of these children, to allow an adequate period of assessment and planning prior to surgery [58]. The recovery from anaesthesia and surgery is a critical period as upper airway obstruction and apnoea with hypoxia may continue for several days postoperatively [5,23,40,59,60]. In addition, postoperative cardiac failure with pulmonary oedema can develop [61].…”

“…This may lead to severe hypoxia in the peri-operative period which can persist postoperatively [40]. Most authors state that pre-operative sedative drugs are contraindicated in children with obstructive sleep apnoea [23,40,42].…”

“…An inhalational induction produces a smooth transition from spontaneous to assisted ventilation which may ease the management of a difficult airway [25,40]. The effects of anaesthesia are reversible if difficulties in maintaining an airway occur.…”

“…Achieving intravenous access may be distressing to the child although this is less likely with the use of topical local anaesthetic creams [23,25]. If the upper airway becomes obstructed during induction this can usually be relieved by jaw manipulation, the use of an oral or nasal pharyngeal airway or the use of CPAP [25,40,43].…”