Risk factors for desaturation after tonsillectomy

Kieran, Stephen; Gorman, Caroline; Kirby, Alexann; Oyemwense, Naomi; Lander, Lina; Schwartz, Margot; Roberson, David W.

doi:10.1002/lary.23956

Cited by 50 publications

(32 citation statements)

References 39 publications

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“… 19,22,23 These complications range from oxygen desaturation below 90% that could be managed with supplemental oxygen to respiratory distress requiring reintubation. These findings are consistent with previous large‐scale studies showing that children with neurological comorbidities have an increased risk of respiratory problems following AT 36 . This information is valuable when counseling patients and families on the risks associated with AT in children with CP, as well as for the healthcare team when deciding how to best care for these complex patients.…”

Section: Discussionsupporting

confidence: 90%

“…These findings are consistent with previous large-scale studies showing that children with neurological comorbidities have an increased risk of respiratory problems following AT. 36 This information is valuable when counseling patients and families on the risks associated with AT in children with CP, as well as for the healthcare team when deciding how to best care for these complex patients. Careful monitoring for secretion management is imperative as a child's baseline difficulty with secretion clearance may be exacerbated by postoperative sedation, pain, and swelling.…”

Section: Intraoperative and Anesthetic Risksmentioning

confidence: 99%

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Risks and Benefits of Adenotonsillectomy in Children With Cerebral Palsy With Obstructive Sleep Apnea: A Systematic Review

et al. 2021

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Objectives/Hypothesis Assess the risks and benefits of adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in children with cerebral palsy (CP). Study Design Systematic review. Methods We conducted a systematic review of Medline, Embase, and Cochrane Central Registry from 1946 to 2021. Broad search concepts included cerebral palsy, pediatric, tonsillectomy/adenoidectomy, and sleep. Additional articles were identified by searching reference lists. Studies on the safety and efficacy of AT for OSA management in children with CP were included. Results Fifteen articles met inclusion criteria. Articles were classified into one or more of four themes: intraoperative risk (n = 1), postoperative risk (n = 3), postoperative care requirements (n = 6), and surgical outcomes (n = 7). No intraoperative anesthetic complications were reported. Postoperatively, respiratory complications including pneumonia were common and necessitated additional airway management. Following AT, children with CP required close postoperative observation, experienced increased lengths of stay, and had increased odds of unplanned intensive care unit (ICU) admission. Benefits following AT were improvement in OSA as measured by a reduction in obstructive apnea‐hypopnea index (OAHI) as well as improved quality of life in some; however, many patients went on to require tracheostomy due to persistent OSA. Conclusions Children with CP who undergo AT have a significant risk of developing a postoperative respiratory complication. Realistic counseling of families around increased perioperative risks in this population is imperative and close postoperative monitoring is critical. Many children will obtain a reduction in OAHI, but additional surgical management is often required, including tracheostomy. Further research is needed to determine the best management strategy for OSA in children with CP. Laryngoscope, 132:687–694, 2022

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Section: Discussionsupporting

confidence: 90%

Section: Intraoperative and Anesthetic Risksmentioning

confidence: 99%

Risks and Benefits of Adenotonsillectomy in Children With Cerebral Palsy With Obstructive Sleep Apnea: A Systematic Review

et al. 2021

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“…37 Much consideration and debate has been given to the question of admission and observation following tonsillectomy. There is wide variation in patterns of admission after tonsillectomy 54 and little standardization of monitoring practices. Such variation is central to the national dialogue on patient safety and resource utilization.…”

Section: Discussionmentioning

confidence: 99%

“…Because desaturation may occur with normal respiratory rate, measurements of respiratory rate without oximetry may fail to identify some patients at risk. 55 Work by Kieran and colleagues 54 comparing characteristics of those children who desaturated with those who did not in a consecutive sample of >4,000 patients provides a starting point, but much remains to be done to understand the cost-benefit value of admitting patients for monitoring.…”

Section: Discussionmentioning

confidence: 99%

Mortality and major morbidity after tonsillectomy

et al. 2013

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“…In addition, the termination of an episode of obstructive apnea in children with OSA is reliant on an arousal from sleep and recruitment of the upper airway muscles to maintain airway patency, both of which are diminished by postoperative opioids. [14][15][16][17] To our knowledge, this is the first study to utilize tcPCO2 monitoring to measure hypoventilation in children undergoing adenotonsillectomy. Although limited, there have been previous studies that have demonstrated the potential intraoperative applications of tcPCO2 monitoring in both the adult and pediatric populations.…”

Section: Discussionmentioning

confidence: 99%

Transcutaneous CO₂ Monitoring in Children Undergoing Tonsillectomy for Sleep Disordered Breathing

et al. 2020

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Objectives/Hypothesis: Children undergoing tonsillectomy for sleep-disordered breathing are at risk for respiratory compromise when narcotics are administered. Severe complications resulting from hypoxia can include neuro-devastation and death. The objective of this prospective study was to evaluate the feasibility, accuracy, and utility of transcutaneous carbon dioxide (tcPCO2) monitoring during and after adenotonsillectomy.Study Design: Prospective, Observational study. Methods: Twenty-nine children with sleep-disordered breathing scheduled for adenotonsillectomy were included in the study. Peri-operative measurements of tcPCO2 were compared against a single venous blood sample (PaCO2) and end-tidal (ET) CO2. The differences between ETCO2, tcPCO2 measures, and PaCO2 were examined using non-paired t-tests and linear regression. Parameters from PSG were recorded and associations with tcPCO2 values were performed using linear regression analysis. Group comparisons were made between pre-, intra-, and post-operative tcPCO2 measurements.Results: Similar to ETCO2, there was good correlation of tcPCO2 to PaCO2. Children with lower oxygen (O2) saturation nadirs had higher peak CO2 levels during surgery and spent a greater proportion of time with CO2 > 50 mmHg in the recovery room (P < .01 and P < .08). Other PSG measures (apnea-hypopnea index, O2 desaturation index, and peak CO2) did not have any significant correlation. Frequent episodes of hypercapnia were noted intra-and post-operatively and mean tcPCO2 values during both periods were significantly higher than baseline (P < .001).Conclusions: tcPCO2 monitoring is viable in children undergoing adenotonsillectomy and can provide a good estimate of hypoventilation. tcPCO2 measurements may have particular benefit in the post-operative setting and may assist in identifying children at greater risk for respiratory complications.

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Risk factors for desaturation after tonsillectomy

Abstract: 3b.

Cited by 50 publications

References 39 publications

Risks and Benefits of Adenotonsillectomy in Children With Cerebral Palsy With Obstructive Sleep Apnea: A Systematic Review

Risks and Benefits of Adenotonsillectomy in Children With Cerebral Palsy With Obstructive Sleep Apnea: A Systematic Review

Mortality and major morbidity after tonsillectomy

Transcutaneous CO₂ Monitoring in Children Undergoing Tonsillectomy for Sleep Disordered Breathing

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Risk factors for desaturation after tonsillectomy

Abstract: 3b.

Cited by 50 publications

References 39 publications

Risks and Benefits of Adenotonsillectomy in Children With Cerebral Palsy With Obstructive Sleep Apnea: A Systematic Review

Risks and Benefits of Adenotonsillectomy in Children With Cerebral Palsy With Obstructive Sleep Apnea: A Systematic Review

Mortality and major morbidity after tonsillectomy

Transcutaneous CO2 Monitoring in Children Undergoing Tonsillectomy for Sleep Disordered Breathing

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Product

Resources

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Transcutaneous CO₂ Monitoring in Children Undergoing Tonsillectomy for Sleep Disordered Breathing