Paediatric obstructive sleep apnoea: is our operative management evidence-based?

Pabla, L.; Duffin, James; Flood, L M; Blackmore, K

doi:10.1017/s002221511800021x

Cited by 5 publications

(5 citation statements)

References 35 publications

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“…In addition, some of the panelists felt that observation should include children with moderate OSA as well, but this did not reach a consensus. Pabla et al 80 noted “continuing uncertainty around the prediction of the level of postoperative care which any individual child might require.” Based on this concept, the group felt that surgeons should err on the side of caution in children with severe OSA, particularly in those children who are members of high‐risk populations.…”

Section: Discussionmentioning

confidence: 99%

Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy

Ishman

Maturo

Schwartz

et al. 2023

Otolaryngol.--head neck surg.

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Objective To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged. Methods An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology‐Head and Neck Surgery to develop statements for a target population of children aged 2‐18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey. Results After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug‐induced sleep endoscopy, surgical management, and postoperative care. Conclusion The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research.

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Section: Discussionmentioning

confidence: 99%

Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy

Ishman

Maturo

Schwartz

et al. 2023

Otolaryngol.--head neck surg.

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“…Frente a un paciente con SAHOS persistente lo primero a determinar es el o los niveles a los cuales ocurre el colapso de la VAS. Si bien, no hay consenso sobre los métodos óptimos para identificar sitios de obstrucción de la VAS en niños con enfermedad persistente pos-AA 28 , la endoscopía del sueño inducida por fármacos (DISE) y las imágenes de resonancia magnética cine (RM cine) son las más utilizadas. En ambas técnicas, se evalúan múltiples sitios anatómicos en forma dinámica mientras el paciente se encuentra bajo sueño inducido farmacológicamente y en ventilación espontánea intentando simular el sueño fisiológico 18 .…”

Section: Enfrentamiento Del Paciente Con Sahos Persistenteunclassified

Síndrome de apnea obstructiva del sueño persistente en niños adenoamigdalectomizados: artículo de revisión

Ringler

Gajardo

2021

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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“…A recent suggestion has been to perform partial tonsillectomy to reduce airway obstruction while avoiding complete tonsillectomy and thus significantly reducing postoperative pain and the need for postoperative opioids. 18,19 Be aware that airway obstruction may become worse during the first postoperative night despite removal of the enlarged tonsils. 48…”

Section: Surgical Considerationsmentioning

confidence: 99%

“…17 However, that means 30% are not cured; there is no evidence that tonsillotomy alters outcome except to reduce surgical complications. 18,19 The estimated mortality in the USA is ~ 1/2 360 -1/18 000 procedures. 17 Other measures such as weight loss, uvulopalatopharyngoplasty, mandibular advancement, tongue base reduction, CPAP, BiPAP, and variable positive airway pressure (VPAP) may be needed.…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea and polymorphisms: implications for anaesthesia care

CotÃ

2020

South Afr J Anaesth Analg

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With a worldwide obesity pandemic, the incidence of obstructive sleep apnoea (OSA) is increasing; obesity is the most significant risk factor in children. Increasing evidence suggests that OSA is in part mediated through markers of inflammation. Systemic and pulmonary hypertension, right ventricular hypertrophy, prediabetes, and other conditions are common. Adenotonsillectomy improves only ~70% of children; 30% require other interventions, e.g. weight loss programs. The gold standard for diagnosis is a sleep-polysomnogram which are expensive and not readily available. The McGill oximetry score (saw-tooth desaturations during obstruction and arousal) is more cost-effective. Repeated episodes of desaturation alter the opioid receptors such that analgesia is achieved at much lower levels of opioid than in patients undergoing the same procedure but without OSA. This response is of great concern because a standard dose of opioids may be a relative overdose. Polymorphism variations in cytochrome CYP2D6 have major effects upon drug efficacy and side effects. Codeine, hydrocodone, oxycodone, and tramadol are all prodrugs that require CYP2D6 for conversion to the active compound. CYP2D6 is quite variable and patients can be divided into 4 classes: For codeine for example, poor metaboliser (PM) have virtually no conversion to morphine, intermediate metabolisers (IM) have some conversion to morphine, extensive metabolisers (EM) have a normal rate of conversion to morphine, and ultra-rapid metabolisers (RM) convert excessive amounts of codeine to morphine. Such variations result in some patients achieving no analgesia because there is reduced conversion to the active moiety whereas others convert an excessive amount of drug to the active compound thus resulting in relative or actual overdose despite appropriate dosing. Thus, OSA patients may have both opioid sensitivity due to recurrent desaturations and altered drug metabolism resulting in higher than intended blood levels of opioid. OSA patients should only receive one-third to half the usual dose of opioid. In those under the age of six, an effort should be made to avoid opioids altogether and use opioid sparing techniques such as alternating acetaminophen and ibuprofen.

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Paediatric obstructive sleep apnoea: is our operative management evidence-based?

Cited by 5 publications

References 35 publications

Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy

Expert Consensus Statement: Management of Pediatric Persistent Obstructive Sleep Apnea After Adenotonsillectomy

Síndrome de apnea obstructiva del sueño persistente en niños adenoamigdalectomizados: artículo de revisión

Obstructive sleep apnoea and polymorphisms: implications for anaesthesia care

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