Electrocardiographic signs of pulmonary hypertension in children who snore.

Abstract

Two children presented with sleep disturbance due to enlarged 1;onsils and adenoids. One child died during induction of anaesthesia, and postmortem examination showed hypertrophy of the right ventricle and atrium. As a result a prospective survey was carried out of children undergoing tonsillectomy or adenoidectomy, or both. During a nine-month period an electrocardiogram was taken in 92 children. Three electrocardiograms (3-3%) showed evidence of right heart strain. The children with abnormal electrocardiograms had symptoms of sleep disturbance with apnoea, snoring, and daytime somnolence. These symptoms and the electrocardiographic changes were reversed by adenotonsillectomy.The prevalence of pulmonary hypertension in children with enlarged tonsils and adenoids is still underestimated. When signs and symptoms of sleep disturbance, particularly snoring, are present an electrocardiogram should be obtained and a cardiologist's opinion sought before embarking on routine surgery in view of the potentially fatal consequences.

Çocuklarda kronik adenotonsiller hipertrofinin büyüme üzerine etkilerinin adenotonsillektomi öncesi ve sonrası dönemde değerlendirilmesi

“…The American Pediatrics Academy considered growth failure as a severe complication of untreated obstructive sleep apnea (18). In addition, adenotonsillar hypertrophy may lead to sequelae including pulmonary hypertension, cor pulmonale, facial developmental disorders and behavioral disorders disturbing the quality of life (19,20,21).…”

Obstructive sleep apnoea syndrome in children

“…The ECG may indicate the presence of cor pulmonale [25,38] with a large P wave in leads II and V1, a large R wave in V1 and a deep S wave in V6. Wilkinson et al noted that 3% of children presenting for adenotonsillectomy had features of right ventricular strain on the ECG [42]. If features of right atrial or ventricular hypertrophy exist, a chest radiograph is useful in assessing the degree of cardiac enlargement and the possible presence of pulmonary oedema [29].…”

“…This may lead to severe hypoxia in the peri-operative period which can persist postoperatively [40]. Most authors state that pre-operative sedative drugs are contraindicated in children with obstructive sleep apnoea [23,40,42]. The use of anticholinergic drugs such as atropine or glycopyrrolate which act as antisialogogues may reduce the risk of laryngospasm.…”

“…Whether spontaneous or controlled ventilation should be used for adenotonsillectomy in the general population is controversial [42,58,67]. In the USA, most anaesthetists advocate controlled ventilation, while in the UK spontaneous ventilation is most commonly used.…”

“…Nonsteroidal anti-inflammatory drugs do not produce sedation but may, in theory, aggravate bleeding. Alternatively, regular paracetamol 15-20 mg.kg À1 6 hourly either orally or rectally may suffice [42]. If these measures are inadequate, the use of small intravenous doses of morphine, with close monitoring of its effects, can be used although there is a risk of airway compromise.…”