Perioperative Management of Children with Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.

Pediatric Pulmonary Hypertension

“…It is recommended that echocardiography be performed in selected children with OSA awaiting elective surgery who are included in these at-risk conditions, have a past history of lung or heart disease, or have signs of RV dysfunction, systemic hypertension, or multiple hypoxemic episodes on polysomnography. 551 Overall, PH is associated with diverse lung diseases in children, ranging from developmental disorders at birth or in early life to acquired disorders in later childhood. The incidence of PH in these disorders, except for ACD, has not been rigorously evaluated.…”

Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

“…18,19,41,43 Further, opioids are variably metabolized, and in ultra-rapid A 43 Some anesthesiologists recommend a non-opioid regimen with nonsteroidal anti-inflammatory drugs for management of postoperative pain in AT, but their association with postoperative bleeding makes their use controversial. 44,45 In our study, narcotic doses did not correlate with severity of obstructive or central events following surgery, but our patient numbers were small, and we did not measure inherent opioid metabolism. The total narcotic doses were within the recommended safe range.…”

Morphine or Ibuprofen for Post-Tonsillectomy Analgesia: A Randomized Trial

“…1 During sleep, children who have SDB have recurrent episodes of full or partial airway obstruction resulting in hypoxemia, hypercarbia, and sleep disruption. 2 In children, SDB is often caused by hypertrophy of the tonsils and/or adenoids and is commonly managed by tonsillectomy with or without adenoidectomy. 3 The pain associated with this procedure is moderate to severe and more than 500 000 tonsillectomies are performed on children in the United States every year.…”