Are nocturnal hypoxemia and hypercapnia associated with desaturation immediately after adenotonsillectomy?

Abstract

Background Children who undergo adenotonsillectomy for sleep-disordered breathing frequently have postoperative oxygen desaturations. Nocturnal hypoxia has been shown to predict post-operative respiratory complications, however, other gas exchange abnormalities detected on polysomnography (PSG) have not been evaluated. Aim We sought to determine whether hypercarbia seen on preoperative nocturnal PSG can predict postoperative hypoxemia. Methods We conducted a retrospective review of 319 children who underwent polysomnography before adenotonsillectomy. Saturation levels were recorded for at least 2 hours postoperatively, and the primary outcome was desaturation (<90%). Results The median patient age was 5 years (range, 5 months-17 years). Patients who desaturated postoperatively had higher median peak end-tidal CO2 (EtCO2) levels (55.5 vs. 52 mmHg; P=0.02), lower saturation nadirs (80.5% vs. 88%; P=0.048), and were younger (2 vs. 6 years; P<0.001) than those without desaturation. Age was significantly correlated with peak EtCO2 (r= −0.16), respiratory disturbance index (RDI; r= −0.23), and oxygen saturation nadir (r= 0.25; all P<0.01). In unadjusted analysis, age<3 years compared to ≥9 years (odds ratio [OR]=10.09; 95% confidence interval [CI]=2.13–96.26), peak EtCO2>55 mmHg (OR=3.38; 95% CI=1.21–9.47), and RDI≥10 (OR=2.89; 95% CI=1.05–8.42) were associated with increased odds of desaturation. Multivariable logistic regression on age, race, sex, peak EtCO2, RDI, opioid use, and saturation nadir showed that only age was significantly associated with postoperative desaturation. Patients 0–2 years old were 10.43 (95% CI=1.89–110.9) times more likely to have desaturation than patients 9–17 years old. Conclusion Patients less than 3 years of age are most likely to have postoperative hypoxemia after adenotonsillectomy. Gas exchange abnormalities did not correlate with postoperative desaturations, although age and peak EtCO2 did strongly correlate.

Predictors of hypoxemia after general anesthesia in the early postoperative period in a hospital in Ethiopia: An observational study

“…This occurrence is common in the post-anesthesia care unit after major abdominal, orthopedic, gynecologic, and obstetrics procedures [ 1 ]. It is not restricted to the seriously ill patients but may occur in otherwise healthy ones [ 3 , 4 ]. Postoperative hypoxemia occurred secondary to impaired gas exchange during anesthesia as a result of reduced tone in the muscles of the chest wall persisting into the postoperative period [ 5 , 6 ].…”

The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta‐analysis

“…Riaz et al 28 was the only study to divide the selected children into two equal groups, enrolling a matched control group of children without OSA, possibly leading to the high heterogeneity found in some of our statistical analyses. The presence of any comorbidity other than OSA was an exclusion criterion in Camacho et al, 15 Dalesio et al, 17 Martins et al, 32 Riaz et al, 28 and Sanders et al, 30 A study by Gherke et al, 27 excluded children who had undergone additional surgeries. Detailed information on each study can be found in the study characteristics table (Table 1).…”

“…With the inclusion of five studies 15,17–19,24 that supplied precise information about the severity of OSA, the PoRCs rate was analyzed in each OSA severity subgroup and compared individually to non‐OSA patients. Based on the analysis, no significant difference was found in the case of mild OSA ( p = 0.619, OR: 1.15, 95% CI [0.651, 2.058]), but a significantly higher probability of PoRCs was observed in moderate ( p = 0.048, OR: 1.79, 95% CI [1.004, 3.194]) and severe OSA ( p = 0.002, OR: 4.06, 95% CI [1.68, 9.81]) compared to non‐OSA patients.…”

“…OSA is a common disorder in childhood, that without treatment can have severe consequences (behavioral, cardiovascular, or neurocognitive) 3 . Since in the pediatric population OSA has come to be the primary indication for AT surgeries where adverse respiratory events are a known side effect, postoperative monitoring should be planned precisely 17 …”

The Influence of Peripheral Chemoreflex Sensitivity on the Critical Incidents Rate During Combined Anesthesia

“…[10]; уменьшение частоты сердечных сокращений более, чем на 20% от исходного уровня или <50 мин -1 [11]; нарушения ритма сердца (в том числе увеличение частоты сердечных сокращений >100 мин -1 ) [12]; b) связанные с дыхательной системой: снижение насыщения кислородом гемоглобина по данным пульсоксиметрии <95%); увеличение парциального давления углекислого газа в конце выдоха >40 мм рт. ст.)…”