Postoperative acute respiratory insufficiency following adenotonsillectomy in children with neuropathy

Evaluate the incidence of acute respiratory insufficiency (ARI) in the immediate postoperative period following adenotonsillectomy in children with neurological diseases.

Medical records from all pediatric adenotonsillectomies performed from January 1997 through August 2003 at the Roberto de Abreu Sodré Hospital of the Association for the Welfare of Physically Handicapped Children (AACD) in São Paulo were reviewed. Data were collected for patient age, neurological diagnosis, associated comorbidities, index of respiratory insufficiency in the immediate postoperative period and period of hospitalization.

One hundred and nine patients charts had sufficient documentation to be included in this study. Of these, 15 (13.7%) developed ARI in the immediate postoperative period. Ages ranged from 1 to 12 years old (average of 5). Of the 15 patients that presented ARI, 10 (67%) were intubated in the first 3h following extubation. The predominant neurological diagnosis was non-progressive chronic encephalopathy, observed in 84 children (77%), and, among that, 14 (17%) presented ARI. Other neurological diagnoses present in this study were Rett syndrome, neuromuscular disease and meningomyelocele. All of the children that developed ARI presented quadriplegia. Among children that did not develop ARI, the predominant motor pattern was: 28 with quadriplegia, 38 diplegia, 10 hemiplegia, 12 with involuntary movement (choeroathethosis) and six without motor involvement. Children presenting ARI needed mechanical ventilation for an average of 37.87 h (1.5 days) in the intensive care unit. ARI increased the period of hospitalization; these children had an average length of stay of 7 days versus 1.5 days for those that did not develop complications.

Children with neurological disorders, especially those with quadriplegic pattern of motor involvement and severe oropharyngeal dysphagia, are at higher risk for respiratory insufficiency in immediate postoperative period of adenotonsillectomy and should be observed in intensive care unit.