Safety and cost of drug‐induced sleep endoscopy outside the operating room

Abstract

Introduction Drug‐induced sleep endoscopy (DISE) is used to assess site of obstruction for patients in a pharmacologically induced sleep‐like state. It is traditionally performed in the operating room (OR), however, no data exists regarding the feasibility of this intervention outside the OR in children. The objective is to compare the safety of DISE performed in the MRI induction room to those performed in the OR. Methods Prospective case‐series of patients undergoing DISE in the MRI induction room (study group) to those assessed in the OR (controls) in a single‐institution pediatric tertiary care center. Consecutive patients undergoing DISE examination for persistent obstructive sleep apnea (OSA) after adenotonsillectomy from September 2016 to September 2017 were included. Results Overall, 118 patients (38 study patients, 80 controls) with a mean age of 10.6 years (95% confidence interval [CI], 9.3–11.9) underwent DISE; 39.8% (47/118) were female. The most frequent comorbidity was cardiac disease (22.0%, 26/118). The mean obstructive apnea‐hypopnea index was 12.2 events/hour (95% CI, 8.8–15.6) for controls and 13.5 events/hour (95% CI, 8.7–18.3) for study patients (P = .76). No major complication or unplanned admissions occurred in either group. Induction time was similar (12 vs. 13 minutes, P = .7) as was total procedure time (12 vs. 14 minutes, P = .3) for procedures performed in both settings. Conclusion There were no significant complications for DISE performed in the OR or the MRI induction room and procedure times were similar. Further assessment of patient outcomes and resource utilization is needed. Level of Evidence 4 Laryngoscope, 130: 2076–2080, 2020

Expert Consensus Statement: Pediatric Drug‐Induced Sleep Endoscopy

“…Overall, DISE is safe and well tolerated in children with OSA, even those with comorbid conditions, such as obesity, hypotonia, and Down syndrome 42,71–73 . Potential complications include intraoperative loss of airway from laryngospasm or bronchospasm, oversedation, hypotension, bradycardia, and respiratory depression 21 .…”

“…For example, providers have safely performed DISE in the radiology department following cine MRI. In a review of 118 children undergoing DISE in an MRI induction suite, there were no unplanned admissions or major complications 72 . Performing DISE outside the operating room may also result in cost reductions 72 …”

“…Overall, DISE is safe and well tolerated in children with OSA, even those with comorbid conditions, such as obesity, hypotonia, and Down syndrome. 42,[71][72][73] Potential complications include intraoperative loss of airway from laryngospasm or bronchospasm, oversedation, hypotension, bradycardia, and respiratory depression. 21 Thus, DISE should be performed in a setting that allows for cardiopulmonary monitoring, intravenous access, availability of emergency airway equipment, and presence of a skilled team of anesthesia personnel.…”

Pediatric drug‐induced sleep endoscopy: An updated review of the literature

“…In a recent publication by Bergeron et al, 50 the authors described their institutional experience in performing DISE in the MR induction room compared to DISE completed in the traditional operating room. No major complications occurred, and total time of procedure was similar.…”

Safety and Feasibility of Hypnosis-induced Sleep Endoscopy in Obstructive Sleep Apnea Patients: Our Experience.

“…HISE is a cost-effective approach, which is probably its most important advantage. Indeed, the use of drugs, the occupation of the operating room and the requirement of the anesthesiologist team are all costs [10] that we may avoided using HISE. Moreover, HISE may be interesting for patients with drug contraindication.…”