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Preoperative sedation in pediatric patients with sleep-disordered breathing
Anthony Cultrara1, Garrett H Bennett, Craig Lazar
1Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203-2098, USA. cultrata@yahoo.com
Insights
Pediatric patients with sleep-disordered breathing (SDB) receiving preoperative sedation showed no increased risk of airway obstruction. This suggests sedation may be safely administered to children with SDB under close observation.
Area of Science:
- Pediatric Anesthesiology
- Sleep Medicine
- Critical Care
Background:
- Obstructive sleep apnea (OSA) is linked to increased risk of upper airway obstruction (UAO) post-sedation.
- Children with sleep-disordered breathing (SDB) are often undertreated with preoperative sedation due to perceived risks.
- This study investigates the safety of preoperative sedation in pediatric SDB patients.
Purpose of the Study:
- To evaluate the incidence of preoperative airway obstruction in pediatric patients with SDB who received midazolam hydrochloride sedation.
- To determine if preoperative sedation increases the risk of adverse respiratory events in this population.
Main Methods:
- Retrospective chart review of 65 pediatric patients with SDB from 1995-2000.
- Patients received midazolam hydrochloride prior to surgery.
- Adverse events included UAO, hypoventilation, desaturation, bradycardia, or lethargy requiring intervention.
Main Results:
- No patients experienced respiratory compromise requiring intervention after midazolam administration.
- Factors like age, sex, weight, comorbidities, dose, and OSA severity did not impact outcomes.
- Preliminary findings indicate a low risk of adverse events.
Conclusions:
- Preoperative sedation with midazolam may be safely administered to children with mild to moderate SDB.
- Sedation might be feasible for severe OSA patients with vigilant monitoring.
- Further prospective studies are recommended to validate these findings.
Objective:
Based on a few reports that describe obstructive sleep apnea (OSA) patients as having an increased risk of acute upper airway obstruction (UAO) after pharmacological sedation, this population is less likely to receive sedation prior to surgery. Our objective was to evaluate pediatric patients with sleep-disordered breathing who received preoperative sedation to determine if there was an increase in preoperative airway obstruction.
Design:
Retrospective chart review from 1995 to 2000.
Setting:
Two tertiary care academic medical centers.
Patients:
Sixty-five children (mean age=4.7+/-2.3 years; 49 boys, 16 girls) diagnosed with sleep-disordered breathing by sleep study or clinical evaluation that received preoperative midazolam hydrochloride.
Outcome Measure:
The occurrence of preoperative adverse events defined as UAO, hypoventilation, desaturation, bradycardia, or sustained lethargy that required active intervention after the administration of midazolam hydrochloride within 24 h of surgery.
Results:
None of the 65 children evaluated in this study experienced respiratory compromise requiring intervention after the administration of preoperative sedation. Potential risk factors such as patients' age, sex, weight, comorbidities, midazolam hydrochloride dose, and severity of sleep apnea did not appear to affect outcome.
Conclusion:
The preliminary data suggested that preoperative sedation might be safely administered to children with mild or moderate sleep-disordered breathing, and possibly to children with severe OSA, if children are closely observed prior to surgery. Further prospective studies are needed to confirm these results.