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Published on: August 2, 2024
Perioperative respiratory complications following awake and deep extubation in children undergoing adenotonsillectomy
Rahul G Baijal1, Sudha A Bidani, Charles G Minard
1Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.
Insights
Awake versus deep tracheal extubation showed no difference in perioperative respiratory complications for children undergoing adenotonsillectomy. Only low weight (≤14 kg) was linked to increased complications, highlighting weight as a key risk factor.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Pediatric Surgery
- Respiratory Medicine
Background:
- Perioperative respiratory complications are frequent after adenotonsillectomy (T&A), particularly in younger children and those with specific comorbidities.
- Risk factors include young age (<3 years), craniofacial abnormalities, Down syndrome, obstructive sleep apnea, obesity, and failure to thrive.
Purpose of the Study:
- To compare the incidence of perioperative respiratory complications between awake and deep tracheal extubation in pediatric T&A patients.
- To identify factors associated with increased risk of respiratory complications.
Main Methods:
- Retrospective analysis of pediatric patients undergoing T&A.
- Categorization of respiratory complications into major (reinstrumentation, positive airway pressure, ventilation) and minor (hypoxemia).
- Statistical comparison of complication rates between awake and deep extubation groups, with analysis of various patient and anesthetic factors.
Main Results:
- No statistically significant difference in overall perioperative respiratory complications between awake (18.5%) and deep (18.9%) extubation groups (P=0.93).
- Low body weight (≤14 kg) was the only significant predictor of increased perioperative respiratory complications (P=0.005).
- Factors such as age, specific comorbidities (Down syndrome, craniofacial abnormalities, OSA), URI, reactive airway disease, and anesthetic details were not significantly associated with complications.
Conclusions:
- The method of tracheal extubation (awake vs. deep) does not influence the risk of perioperative respiratory complications in pediatric T&A.
- Low body weight is a critical risk factor for perioperative respiratory complications in this patient population.
- Clinical focus should be on identifying and managing low-weight pediatric patients to mitigate respiratory risks during T&A recovery.
Background:
Perioperative respiratory complications after adenotonsillectomy (T&A) are common and have been described to occur more frequently in children below 3 years of age, those with cranio-facial abnormalities, Down syndrome, obstructive sleep apnea, morbid obesity, and failure to thrive.
Aims:
To investigate the association between awake vs deep tracheal extubation and perioperative respiratory conditions.
Results:
The primary outcome was any perioperative respiratory complication. Major complications included the need for airway reinstrumentation, continuous or bi-level positive airway pressure (CPAP or BiPAP) and ventilation, or pharmacologic intervention for managing airway obstruction. Minor respiratory complications included persistent hypoxemia defined as oxygen saturation (SpO2 ) <92% for ≥30 s or postoperative oxygen dependence for hypoxemia for ≥15 min. There was no statistically significant difference in the incidence of any perioperative respiratory complication in children undergoing an awake vs deep extubation (18.5% and 18.9% for awake and deep extubation, respectively (P = 0.93)). Only low weight (≤14 kg) was associated with increased perioperative respiratory complications (P = 0.005). In this study, factors found not to be statistically significant with perioperative respiratory complications included age; presence of Down syndrome, cranio-facial abnormality, or cerebral palsy; obstructive sleep apnea confirmed by polysomnography; diagnosis of obstructive sleep apnea by clinical history; presence of an upper respiratory tract infection (URI) within 2 weeks of presentation; history of reactive airway disease; status at extubation; endtidal sevoflurane and carbon dioxide concentrations at extubation; total intraoperative opioids administered in morphine equivalents (mg·kg(-1) ); administration of propofol at extubation; and intraoperative administration of an anticholinergic drug.
Conclusions:
There was no difference in the incidence of perioperative respiratory complications in children undergoing a T&A following an awake vs deep extubation. Only weight ≤14 kg was associated with increased perioperative respiratory complications.
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