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Medline ® Abstracts for References 105,106

of 'Evaluation of suspected obstructive sleep apnea in children'

The safety of preoperative sedation in children with sleep-disordered breathing.
Francis A, Eltaki K, Bash T, Cortes S, Mojdehi K, Goldstein NA
Int J Pediatr Otorhinolaryngol. 2006;70(9):1517.
OBJECTIVE: To prospectively monitor children who received preoperative sedation with midazolam hydrochloride prior to adenotonsillectomy (T&A) for treatment of sleep-disordered breathing with continuous pulse-oximetry to detect potential respiratory compromise.
DESIGN: Prospective, observational study.
SETTING: Hospital-based pediatric otolaryngology practice.
PATIENTS: Seventy children, aged 1-12 years, diagnosed with sleep-disordered breathing by clinical evaluation or polysomnography (PSG), with a median RDI of 14.25, undergoing T&A.
METHODS: Children underwent a standardized anesthesia protocol including preoperative oral midazolam hydrochloride 0.5mg/kg, standard American Society of Anesthesiologists (ASA) monitoring, mask induction with sevoflurane, muscle relaxant with reversal if indicated, and intravenous dexamethasone sodium phosphate 0.5mg/kg. Children were monitored in the hospital until discharge criteria were met. Selected children with severe OSA were monitored overnight on the pediatric floor or the pediatric intensive care unit. Adverse respiratory events were defined as upper airway obstruction, hypoventilation, desaturation, bradycardia, or sustained lethargy.
MAIN OUTCOME MEASURES: Incidence of pre and postoperative obstructive complications.
RESULTS: During the study period only two patients (2.9%) had a measurable adverse event directly related to the administration of the sedation.
CONCLUSION: Based on sporadic reports of adverse airway events in children with obstructive sleep apnea receiving sedation, these children frequently do not receive preoperative sedation. Given the low morbidity of preoperative sedation in our population, many children with sleep-disordered breathing may safely be pre-medicated.
State University of New York Downstate, Department of Otolaryngology, 134 Atlantic Ave., Brooklyn, NY 11201, United States. afrancis@downstate.edu<afrancis@downstate.edu>
Urgent adenotonsillectomy: an analysis of risk factors associated with postoperative respiratory morbidity.
Brown KA, Morin I, Hickey C, Manoukian JJ, Nixon GM, Brouillette RT
Anesthesiology. 2003;99(3):586.
BACKGROUND: The aim of this study was to determine the frequency and type of respiratory complications after urgent adenotonsillectomy (study group) for comparison with a control group of children undergoing a sleep study and adenotonsillectomy for obstructive sleep apnea syndrome. A second aim was to assess risk factors predictive of respiratory complications after urgent adenotonsillectomy.
METHODS: The perioperative course of children who underwent adenotonsillectomy between January 1, 1999, and March 31, 2001, was reviewed. Two groups of children were identified from two different databases: the hospital database for surgical procedures (the study group) and the sleep laboratory database (the control group). The retrospective chart review focused on the preoperative status (including an evaluation for obstructive sleep apnea), anesthetic management, and need for postoperative respiratory interventions.
RESULTS: A total of 64 consecutive cases for urgent adenotonsillectomy were identified, and 54 children met the inclusion criteria. Thirty-three children (60%) had postoperative respiratory complications necessitating a medical intervention; 11 (20.3%) required a major intervention (reintubation, ventilation, and/or administration of racemic epinephrine or Ventolin), and 22 (40.7%) required a minor intervention (oxygen administration). Six children (11.1%) required reintubation in the recovery room for respiratory compromise. Risk factors for respiratory complications were an associated medical condition (odds ratio, 8.15; 95% confidence interval, 1.81-36.73) and a preoperative saturation nadir less than 80% (odds ratio, 5.54; 95% confidence interval, 1.15-26.72). Sixteen (49%) of the medical interventions were required within the first postoperative hour. Atropine administration, at induction, decreased the risk of postoperative respiratory complications (odds ratio, 0.18; 95% confidence interval, 0.11-1.050.
CONTROL GROUP: Of 75 children who underwent a sleep study and adenotonsillectomy, 44 had sleep apnea and were admitted to hospital after elective adenotonsillectomy. Sixteen (36.4%) children had postoperative respiratory complications necessitating a medical intervention. Six percent of the children (n = 3) required a major medical intervention. No child required reintubation for respiratory compromise.
CONCLUSIONS: Severe obstructive sleep apnea syndrome and an associated medical condition are risk factors for postadenotonsillectomy respiratory complications. Risk reductions strategies should focus on their assessment.
Division of Anesthesia, McGill University Health Centre Research Institute, McGill University Health Centre/Montreal Children's Hospital, Montreal, Quebec, Canada. roula.cacolyris@muhc.mcgill.ca