Can Assessment for Obstructive Sleep Apnea Help Predict Postadenotonsillectomy Respiratory Complications?

Abstract

The data suggest, but do not prove, that preoperative nocturnal oximetry could be a useful preoperative test to identify children who are at increased risk for postoperative respiratory complications.

High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children

“…[12][13][14] Patients younger than three years, with Down syndrome or with co-morbidities, such as asthma and neuromuscular diseases, as well as those with severe obstructive sleep apnea syndrome are at increased risk for complications after tonsillectomy. 14,15 Researchers have shown that half of the medical interventions performed to treat respiratory morbidity in children undergoing tonsillectomy are needed within the first postoperative hour. 15 Furthermore, researchers showed that children with obstructive sleep apnea appear to have increased sensitivity to opioids, and respiratory complications after adenotonsillectomies are often seen within two hours of opioid administration.…”

Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon

“…5 The inclusion criteria were: 1) a sleep study documenting severe OSAS; 2) adenotonsillectomy within six months prior to surgery; and 3) extubation in the operating room at the end of surgery. The diagnostic criterion for severe OSAS was an abnormal sleep study defined, in our institution and elsewhere, 8 by an obstructive apnea and hypopnea (OAH) index > 5 events·hr -1 .…”

“…Details of our sleep study recording systems have been published elsewhere. [9][10][11][12] Although the studies were analyzed for several variables, 5 only the OAH index and the preoperative saturation nadir (preSaO 2 nadir) are reported. The preSaO 2 nadir was defined as the minimum hemoglobin oxygen saturation regardless of duration and was validated by visual inspection of a computerized data record.…”

“…2 Children with the obstructive sleep apnea syndrome (OSAS) have a higher risk for respiratory morbidity following adenotonsillectomy compared with the general pediatric population. [3][4][5] Quality assurance programs have focused attention on patient characteristics contributing to postoperative risk. 6 An evolving viewpoint emphasizes the need to look beyond the patient, to factors in the health delivery system per se, which may affect outcome.…”

Risk Stratification of Paediatric Obstructive Sleep Apnoea (OSA) for Adenotonsillectomy: How we do it at a UK District General Hospital

“…Furthermore, access may be limited by availability of sleep laboratories, resources and lack of consensus on interpretation of PSGs. The overnight pulse oximetry in place of formal PSG is not only cost effective, but also beneficial for identifying the so called 'normal child with severe OSA' who is otherwise difficult to identify with the history and examination alone [7]. There are two parameters of interest that normally give an indication as to whether the child has OSA or not -the saturation nadir (min SpO2 dip) and the Oxygen Desaturation Index (ODI).…”