scholarly journals Respiratory Complications of Adenotonsillectomy for Obstructive Sleep Apnea in the Pediatric Population

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
G. Marrugo Pardo ◽  
L. F. Romero Moreno ◽  
P. Beltrán Erazo ◽  
C. Villalobos Aguirre
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pediatric Population ◽  
Early Postoperative Period ◽  
Respiratory Complication ◽  
Apnea Hypopnea Index ◽  
Respiratory Complications ◽  
Obstructive Sleep ◽  
Postoperative Respiratory Complications ◽  
Postanesthetic Care Unit

Objective. To determine the prevalence of respiratory complications in the early postoperative period of children with sleep apnea who required adenotonsillectomy at a tertiary pediatric hospital and to establish recommendations for postoperative monitoring. Methods. Retrospective cohort study of children with obstructive sleep apnea (OSA) diagnosed by polysomnogram (PSG), who underwent adenotonsillectomy for treatment of OSA. The prevalence of respiratory complications in the first 24 postoperative hours was measured. Patients with craniofacial malformations, obesity, and severe cardiovascular comorbidities were excluded. The prevalence of postoperative respiratory complications was compared with the severity of OSA according to the Apnea Hypopnea Index (AHI) and NADIR. All data were taken in patients residing in Bogotá city, Colombia, at 2.640 meters above sea level (m.a.s.l). Results. Between May 2014 and February 2017, 167 patients (108 males) required adenotonsillectomy for OSA, with an age range of 1 and 15 years (mean 5.3 years +/- 2.7). The prevalence of postoperative respiratory complications was 3.59% (6/167). There was a statistically significant relationship between the presence of respiratory complication and AHI greater than 44/h (p <0.04). There was an inverse correlation between the AHI and NADIR values. Risk groups of patients younger than 3 years and NADIR less than 70% had a higher prevalence of respiratory complications; however, this correlation was not statistically significant (p <0.08 and 0.89, respectively). Conclusions. The prevalence of respiratory complications in OSA patients undergoing adenotonsillectomy in high altitudes is similar to that reported in other heights. Preoperative AHI greater than 44/h could be considered a risk factor for early respiratory complication. We suggest ambulatory management after 6 hours in Postanesthetic Care Unit (PACU) observation in patients older than 3 years, with AHI less than 44/h and NADIR greater than 70% in altitudes higher than 2.500 m.a.s.l. Further research must be done to confirm this hypothesis.

scholarly journals P.069 Respiratory dysfunction and sleep disordered breathing in children with Myasthenia Gravis

2018 ◽  
Vol 45 (s2) ◽  
pp. S34-S34
Author(s):  
HF Qashqari ◽  
I Narang ◽  
H Katzberg ◽  
K Vezina ◽  
A Khayat ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Myasthenia Gravis ◽  
Sleep Disordered Breathing ◽  
Pediatric Population ◽  
Respiratory Muscles ◽  
Apnea Hypopnea Index ◽  
Respiratory Dysfunction ◽  
Obstructive Sleep ◽  
Disordered Breathing

Background: Myasthenia Gravis ( MG) is an autoimmune disease that affects the neuromuscular junction. It typically presents with fluctuating muscle weakness which can affect respiratory muscles. Data about the prevalence of sleep disordered breathing in children with MG and the benefits of non-invasive ventilation outside the setting of MG crisis has not been studied so far. Methods: Eleven children between 3 and 18 years old with confirmed MG were recruited from the The Hospital for Sick Children Neuromuscular clinic in a prospective observational study. Informed consent was obtained and patients underwent PFTs, MIP/MEP, SNIP, FVC and standard polysomnography testing’s. Results: In our study, we found that 2/11 children had abnormal Apnea Hypopnea index (AHI) and were diagnosed with obstructive sleep apnea (OSA). One of them has juvenile ocular MG with mild to moderate OSA and the second child has congenital MG with mild OSA. CPAP therapy was initiated for both patients. Conclusions: In our cohort, obstructive sleep apnea rate was significantly higher in children with MG than the known prevalence in general pediatric population ( 18% vs 2-3% ). Early diagnosis and management of OSA can have great impact on children’s health and quality of life. A larger study is needed to validate our findings.

Urgent Adenotonsillectomy

2003 ◽  
Vol 99 (3) ◽  
pp. 586-595 ◽  
Author(s):  
Karen A. Brown ◽  
Isabelle Morin ◽  
Chantal Hickey ◽  
John J. Manoukian ◽  
Gillian M. Nixon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Medical Intervention ◽  
Control Group ◽  
Respiratory Complications ◽  
Obstructive Sleep ◽  
Postoperative Respiratory Complications

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.

scholarly journals Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea

2015 ◽  
Vol 41 (3) ◽  
pp. 238-245 ◽  
Author(s):  
Renato Oliveira Martins ◽  
Nuria Castello-Branco ◽  
Jefferson Luis de Barros ◽  
Silke Anna Theresa Weber
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Teaching Hospital ◽  
Orotracheal Intubation ◽  
Apnea Hypopnea Index ◽  
Respiratory Complications ◽  
Cross Sectional ◽  
Historical Cohort ◽  
Obstructive Sleep

Objective: To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU). Methods: A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors. Results: Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3 ± 2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea). Conclusions: Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.

scholarly journals Postoperative Respiratory Complications in Patients at Risk for Obstructive Sleep Apnea

2017 ◽  
Vol 125 (1) ◽  
pp. 272-279 ◽  
Author(s):  
Satya Krishna Ramachandran ◽  
Jaideep Pandit ◽  
Scott Devine ◽  
Aleda Thompson ◽  
Amy Shanks
Keyword(s):  
At Risk ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Respiratory Complications ◽  
Obstructive Sleep ◽  
Patients At Risk ◽  
Postoperative Respiratory Complications

Obstructive Sleep Apnea

2018 ◽  
Author(s):  
Laura Ryan ◽  
Paul Hopkins
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Postoperative Nausea And Vomiting ◽  
Respiratory Morbidity ◽  
Respiratory Complications ◽  
Parental History ◽  
Perioperative Analgesia ◽  
Obstructive Sleep ◽  
Postoperative Respiratory Complications ◽  
Overnight Polysomnography

Adenotonsillectomy is one of the most commonly performed surgeries in children and is the mainstay treatment for obstructive sleep apnea (OSA). Children with OSA have a higher risk of perioperative respiratory morbidity. Diagnosis of OSA is made by overnight polysomnography, but this resource is rare and expensive so children at risk for OSA must be identified based on parental history. Patients with risk factors for postoperative respiratory complications may need to be monitored in the hospital overnight. Anesthetic challenges associate with adenotonsillectomy include perioperative analgesia, prevention and treatment of postoperative nausea and vomiting, risk of airway fire, and management of airway obstruction.

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