Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond

Uwiera, Trina C.

doi:10.3390/children8110944

Cited by 6 publications

(3 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When resolution is defined as a postoperative AHI <1 event/hour, adenotonsillectomy has been shown to have a high success rate of 51% to 83%. [7][8][9][10][11] Risk factors for persistent OSA following adenotonsillectomy include obesity, numerous comorbidities (including craniofacial disorders and neuromuscular disorders), and severe preoperative sleep apnea. 7 Persistent OSA can be challenging to treat, as medical therapies, including intranasal corticosteroids, oral leukotriene inhibitors, CPAP, or additional surgeries, 4,12,13 can have varying efficacies depending on the severity of the initial OSA.…”

Section: Introductionmentioning

confidence: 99%

Does REM AHI Predict Persistent OSA After Pediatric Adenotonsillectomy?

Fields,

Poupore,

Barengo

et al. 2024

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objective: The utility of REM AHI in managing pediatric obstructive sleep apnea (OSA) is not fully understood. This study aimed to evaluate the relationship of preoperative REM AHI to postoperative persistence of OSA in children who underwent adenotonsillectomy. Methods: This retrospective chart review identified children under the age of 18 years that received an adenotonsillectomy for OSA and a preoperative and postoperative polysomnogram. Children with craniofacial or neuromuscular disorders or a tracheostomy were excluded. The primary outcome was the postoperative persistence of OSA, defined as a postoperative obstructive apnea-hypopnea index (oAHI) ≥ 1.5 events/hour. REM-predominant OSA was defined as a ratio of REM/NREM AHI ≥ 2. REM AHI minus NREM AHI and REM AHI minus oAHI helped to identify patients with a larger distribution of REM AHI. Results: A total of 353 patients were included. Postoperative persistent OSA was seen in 232 (65.7%) children. The preoperative REM AHI, REM AHI minus NREM AHI, and REM AHI minus oAHI of children with persistent OSA did not differ significantly from children with resolution of OSA. Rates of persistence were not different between those with REM-predominant OSA and REM-independent OSA (63.8% vs 70.7%, P = .218). Conclusion: This study suggests that preoperative REM AHI may be a poor predictor of OSA persistence after adenotonsillectomy. Further study is needed to help characterize how pre-operative REM AHI should impact clinicians’ decision making, family counseling and recommendations.

show abstract

Section: Introductionmentioning

confidence: 99%

Does REM AHI Predict Persistent OSA After Pediatric Adenotonsillectomy?

Fields,

Poupore,

Barengo

et al. 2024

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…The mortality associated with tonsillectomy is an uncommon but well-known consequence 6,7 . The tongue swelling, altered taste, eye injury, lip burn, carotid artery injury and a mandibular condyle fracture have all been described as complications to tonsillectomy 8,9 . Velopharyngeal incompetence or nasopharyngeal stenosis can affect the valving of the nasopharynx.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ligasure versus Bipolar Diathermy Tonsillectomy

Saleem¹,

Khan²,

Ali³

et al. 2023

PJMHS

View full text Add to dashboard Cite

Aim: To compare the operational time, blood loss and consequences of tonsillectomy with Ligasure versus bipolar diathermy. Methods: A total of 106 individuals were randomized to have their Tonsillectomy done with either Ligasure or bipolar diathermy in this prospective trial. The length of procedure, amount of blood lost during it, degree of post-operative pain and the outcomes all were documented and studied. Results: In total, 106 cases were studied, with 53 cases in to the Ligasure Group and 53 cases to Bipolar Tonsillectomy Group. During surgery, bipolar diathermy group lost more amount of blood. The Ligasure group had an average operative time of 4 minutes less. Both groups had similar degrees of postoperative pain. Despite the fact that the Ligasure group had less postoperative hemorrhages than the diathermy group, there was no statistically significant difference. Conclusions: Study concluded that tonsillectomies using ligasure took longer than those with bipolar diathermy. Both groups had similar perioperative hemostasis. The rate of postoperative bleeding was higher than anticipated. Keywords: Ligasure, bipolar diathermy hemorrhage, hemostasis, blood loss during surgery

show abstract

“…Given the sequelae associated with untreated OSA, this series highlights the importance of timely and effective treatment of OSA. Adenotonsillectomy (AT) is the first-line treatment in children with enlarged tonsils and adenoids [ 13 ]. The predictors for post AT respiratory complications requiring intervention are children with severe OSA particularly AHI > 40/h, younger children (<2 years of age), lower oxygen saturation (SpO 2 ), and poor nutritional status which was shown in a retrospective review conducted by Saeid et al [ 14 ].…”

mentioning

confidence: 99%