Respiratory Compromise After Adenotonsillectomy in Children With Obstructive Sleep Apnea

McColley, Susanna A.; April, Max M.; Carroll, John L.; Naclerio, Robert M.; Loughlin, Gerald M.

doi:10.1001/archotol.1992.01880090056017

Cited by 332 publications

(305 citation statements)

References 15 publications

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“…3,4 Surgery performed between 7:45 and 12:59 was designated morning (AM) and after 13:00 was designated afternoon (PM). The season for surgery performed between October and March was assigned to winter and for surgery performed between April and September was assigned to summer.…”

Section: Discussionmentioning

confidence: 99%

“…Univariate analysis of known 3,4 and potential risk factors identified two risk factors: the preoperative SaO 2 nadir risk (< 80% vs $ 80%) and the time of day of surgery (PM vs AM; Table II). These risk factors remained significant when analyzed with a multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, there is an emerging consensus that OSAS severity is an independent risk factor for respiratory morbidity. 3,4,18,19 Furthermore the criteria for stratification of OSAS disease severity for diagnosis and prediction of postoperative respiratory morbidity probably differ. As an example, the criterion for a diagnosis of severe OSAS is an OAH index > 5 events·hr, -1 20 whereas that for prediction of postadenotonsillectomy respiratory morbidity is an OAH index > 10 events·hr -1 .…”

Section: Osas Severitymentioning

confidence: 99%

“…As an example, the criterion for a diagnosis of severe OSAS is an OAH index > 5 events·hr, -1 20 whereas that for prediction of postadenotonsillectomy respiratory morbidity is an OAH index > 10 events·hr -1 . 4 There is a need to develop criteria applicable to an operative setting which define perioperative risk stratification in OSAS.…”

Section: Osas Severitymentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Koomson

Morin

Brouillette

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To determine, in a subset of children previously reported, if the time of day when adenotonsillectomy for severe obstructive sleep apnea syndrome (OSAS) was performed affected the incidence of postoperative respiratory complications.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : Children having adenotonsillectomy were included if they had a polysomnographic diagnosis of severe OSAS within six months prior to operation. Patients who met the inclusion criteria were grouped by the occurrence of postoperative desaturation into a saturated (SAT) and desaturated (deSAT) group. The charts of children in group deSAT were reviewed. The clock time of the surgical procedure was recorded and categorized as morning (AM) or afternoon (PM).R Re es su ul lt ts s: : Eighty-eight patients met the inclusion criteria. There were 31 girls and 57 boys. The mean ± SD age (yr) and weight (kg) were 4.6 ± 2.9 yr and 20.8 ± 14.5 kg respectively. There were 63 children in the SAT group and 25 in the deSAT group. Differences in age, weight and gender were not significant. The preoperative oxygen saturation (SaO 2 ) nadir for the SAT and deSAT groups was 80.8 ± 10.2% and 67.6 ± 17.5% (P < 0.05) respectively. The preoperative obstructive apnea and hypopnea index was 15.8 ± 10.2 and 35.7 ± 34.6 events·hr -1 (P < 0.05), respectively. Surgery in 63 (71.6%) children was performed in the AM. Univariate logistic regression identified PM surgery [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.7 to 12.6, P = 0.002] and a preoperative SaO 2 nadir < 80% (OR 3.6, 95% CI 1.4 to 9.4, P = 0.009) as risk factors predicting postadenotonsillectomy desaturation.C Co on nc cl lu us si io on n: : Children with severe OSAS whose surgery is performed in the AM are less likely to desaturate following adenotonsillectomy than children whose surgery is performed in the PM. 80,8 ± 10,2 % et de 67,6 ± 17,5 % (P < 0,05) de 15,8 ± 10,2 et de 35,7 ± 34,6 événements·h -1 (P < 0,05), respectivement. L'opération de 63 (71,6 %) Éléments cliniques : Des enfants subissant une amygdalectomie ont été inclus dans notre étude si un diagnostic polysomnographique de SAOS sévère avait été établi dans les six mois avant l'opération. Les patients admis ont été répartis selon l'occurrence de désaturation postopératoire dans un groupe de saturation (SAT) ou de désaturation (deSAT). Les dossiers des enfants du groupe deSAT ont été révisés. L'heure de l'opération a été notée sous matin (AM) ou après-midi (PM). Résultats dans les groupes SAT et deSAT respectivement. Les indices d'apnée obstructive et d'hypopnée préopératoires étaient

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%