Predicting Perioperative Respiratory Adverse Events in Children With Sleep-Disordered Breathing

Abstract

BACKGROUND: No evidence currently exists to quantify the risk and incidence of perioperative respiratory adverse events (PRAEs) in children with sleep-disordered breathing (SDB) undergoing all procedures requiring general anesthesia. Our objective was to determine the incidence of PRAEs and the risk factors in children with polysomnography-confirmed SDB undergoing procedures requiring general anesthesia. METHODS: Retrospective review of all patients with polysomnography-confirmed SDB undergoing general anesthesia from January 2009 to December 2013. Demographic and perioperative outcome variables were compared between children who experienced PRAEs and those who did not. Generalized estimating equations were used to build a predictive model of PRAEs. RESULTS: In a cohort of 393 patients, 51 PRAEs occurred during 43 (5.6%) of 771 anesthesia encounters. Using generalized estimating equations, treatment with continuous positive airway pressure or bilevel positive airway pressure (odds ratio, 1.63; 95% confidence interval [CI], 1.05–2.54; P = .031), outpatient (odds ratio, 1.37; 95% CI, 1.03–1.91; P = .047), presence of severe obstructive sleep apnea (odds ratio, 1.63; 95% CI, 1.09–2.42; P = .016), use of preoperative oxygen (odds ratio 1.82; 95% CI, 1.11–2.97; P = .017), history of prematurity (odds ratio, 2.31; 95% CI, 1.33–4.01; P = .003), and intraoperative airway management with endotracheal intubation (odds ratio, 3.03; 95% CI, 1.79–5.14; P < .001) were associated with PRAEs. CONCLUSIONS: We propose the risk factors identified within this cohort of SDB patients could be incorporated into a preoperative risk assessment tool that might better to identify the risk of PRAE during general anesthesia. Further investigation and validation of this model could contribute to improved preoperative risk stratification, decision-making (postoperative admission and level of monitoring), and health care resource allocation.

Racial Inequity in Pediatric Anesthesia

“…Black and Hispanic children are also less likely to receive a tonsillectomy for SDB [ 38 ]. Given that OSA is independently associated with PRAE, minority patients may be at higher risk of adverse events following anesthesia [ 39 ].…”

Associations between perioperative sleep patterns and clinical outcomes in patients with intracranial tumors: a correlation study

“…In patients with intracranial tumors, previous studies have found that more than 60% of patients have sleep disorders, with one in five reporting insomnia ( 9 ). Perioperative sleep disorders can retard wound healing ( 10 ), result in mood disorders and post-operative cognitive dysfunction ( 7 , 11 , 12 ), increase respiratory and cardiovascular complications ( 13 , 14 ), and prolong hospital stays ( 2 ). Different types and degrees of sleep disorders, mainly manifesting as abnormalities in sleep quantity and quality, were under-recognized in clinical studies.…”

Preoperative Predictors of Severe Respiratory Events After Tonsillectomy: Consideration for Pediatric Intensive Care Admission

“…Although AT is one of the most common pediatric procedures performed in the United States, it can result in severe and life‐threatening respiratory events 1,2 . The reported frequency of post‐AT respiratory events ranges widely, from <1% to nearly 60%, depending on the definition of events and population studied 3‐14 . Some children can safely undergo outpatient AT, whereas others require inpatient observation to monitor for postoperative respiratory events.…”

“…1,2 The reported frequency of post-AT respiratory events ranges widely, from <1% to nearly 60%, depending on the definition of events and population studied. [3][4][5][6][7][8][9][10][11][12][13][14] Some children can safely undergo outpatient AT, whereas others require inpatient observation to monitor for postoperative respiratory events. Some children are admitted to the pediatric intensive care unit (PICU) after AT due to perceived increased risk for severe respiratory events (SRE).…”