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Published on: December 6, 2016
The safety of preoperative sedation in children with sleep-disordered breathing
Aren Francis1, Kareem Eltaki, Tal Bash
1State University of New York Downstate, Department of Otolaryngology, 134 Atlantic Ave., Brooklyn, NY 11201, United States. afrancis@downstate.edu <afrancis@downstate.edu>
Insights
Preoperative sedation with midazolam hydrochloride for pediatric adenotonsillectomy (T&A) is safe for treating sleep-disordered breathing. Continuous pulse oximetry monitoring showed a low incidence of adverse respiratory events in children undergoing T&A.
Area of Science:
- Pediatric Anesthesiology
- Otolaryngology
- Sleep Medicine
Background:
- Sleep-disordered breathing (SDB) affects children undergoing adenotonsillectomy (T&A).
- Preoperative sedation is often avoided in these children due to concerns about respiratory compromise.
- Midazolam hydrochloride is a commonly used sedative in pediatric practice.
Purpose of the Study:
- To prospectively monitor children receiving midazolam hydrochloride sedation before T&A for SDB.
- To assess the incidence of respiratory compromise using continuous pulse oximetry.
- To evaluate the safety and efficacy of preoperative sedation in this population.
Main Methods:
- Prospective, observational study in a pediatric otolaryngology practice.
- Seventy children (aged 1-12 years) with SDB underwent T&A with standardized anesthesia, including oral midazolam hydrochloride.
- Continuous pulse oximetry and clinical monitoring were used to detect adverse respiratory events.
Main Results:
- Only two patients (2.9%) experienced measurable adverse events directly related to sedation.
- No significant respiratory compromise was observed during the perioperative period.
- The overall incidence of adverse events was low.
Conclusions:
- Preoperative midazolam hydrochloride sedation is safe for children with SDB undergoing T&A.
- Continuous monitoring can effectively detect potential respiratory issues.
- Many children with SDB may benefit from preoperative sedation, challenging current avoidance practices.
Objective:
To prospectively monitor children who received preoperative sedation with midazolam hydrochloride prior to adenotonsillectomy (T&A) for treatment of sleep-disordered breathing with continuous pulse-oximetry to detect potential respiratory compromise.
Design:
Prospective, observational study.
Setting:
Hospital-based pediatric otolaryngology practice.
Patients:
Seventy children, aged 1-12 years, diagnosed with sleep-disordered breathing by clinical evaluation or polysomnography (PSG), with a median RDI of 14.25, undergoing T&A.
Methods:
Children underwent a standardized anesthesia protocol including preoperative oral midazolam hydrochloride 0.5mg/kg, standard American Society of Anesthesiologists (ASA) monitoring, mask induction with sevoflurane, muscle relaxant with reversal if indicated, and intravenous dexamethasone sodium phosphate 0.5mg/kg. Children were monitored in the hospital until discharge criteria were met. Selected children with severe OSA were monitored overnight on the pediatric floor or the pediatric intensive care unit. Adverse respiratory events were defined as upper airway obstruction, hypoventilation, desaturation, bradycardia, or sustained lethargy.
Main Outcome Measures:
Incidence of pre and postoperative obstructive complications.
Results:
During the study period only two patients (2.9%) had a measurable adverse event directly related to the administration of the sedation.
Conclusion:
Based on sporadic reports of adverse airway events in children with obstructive sleep apnea receiving sedation, these children frequently do not receive preoperative sedation. Given the low morbidity of preoperative sedation in our population, many children with sleep-disordered breathing may safely be pre-medicated.
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