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Published on: December 6, 2016
The STBUR questionnaire for identifying children at risk for sleep-disordered breathing and postoperative
Alan R Tait1, Rebecca Bickham1,2, Louise M O'Brien3,4,5
1Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
Insights
Children with sleep-disordered breathing (SDB) symptoms face a higher risk of perioperative respiratory events (PRAE) and postoperative opioid-related adverse events (ORAE). This highlights the need for careful opioid titration in these pediatric surgical patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Children with symptoms of sleep-disordered breathing (SDB) are recognized as a vulnerable population for perioperative respiratory events (PRAE).
- These children may exhibit increased sensitivity to the respiratory-depressant effects of opioids compared to their peers without SDB.
Purpose of the Study:
- To prospectively confirm that children with SDB symptoms have a higher risk of PRAE than children without SDB.
- To investigate whether children with SDB symptoms are also at increased risk for postoperative opioid-related adverse events (ORAE).
Main Methods:
- Prospective observational study involving 678 parents of children scheduled for surgery.
- Preoperative assessment using the Snoring, Trouble Breathing, and Un-Refreshed (STBUR) questionnaire.
- Prospective data collection on PRAE incidence and postoperative pulse oximetry desaturation events.
Main Results:
- Children with SDB symptoms (≥3 STBUR symptoms) showed a two-fold increased likelihood of PRAE (52.8% vs 27.9%).
- In a subset undergoing airway procedures, children with SDB experienced more postoperative oxygen desaturation alarms (14.14 ± 29.3 vs 7.12 ± 13.2) and required more frequent escalation of care (15.3% vs 7.1%).
- Opioid doses were similar for children with and without SDB symptoms, despite increased desaturations in the SDB group.
Conclusions:
- Pediatric surgical patients with SDB symptoms face elevated risks for both PRAE and ORAE, particularly after airway procedures.
- Current opioid dosing strategies may not adequately account for the increased respiratory risks in children with SDB.
- Titrating postoperative opioid doses based on identified SDB risk is recommended to improve patient safety.
Background:
Children with symptoms of sleep-disordered breathing (SDB) appear to be at risk for perioperative respiratory events (PRAE). Furthermore, these children may be more sensitive to the respiratory-depressant effects of opioids compared with children without SDB.
Aims:
The aim of this prospective observational study was to confirm that otherwise healthy children with symptoms of SDB are at greater risk for PRAE compared with children with no symptoms and to determine if these children are also at increased risk for postoperative opioid-related adverse events (ORAE).
Methods:
Six hundred and seventy-eight parents of children scheduled for surgery completed the Snoring, Trouble Breathing, and Un-Refreshed (STBUR) questionnaire preoperatively. Data regarding the incidence of PRAE were collected prospectively. Postoperative pulse oximetry desaturation alarm events were downloaded from the institutional secondary alarm notification system.
Results:
Children with symptoms of SDB per STBUR (≥3 symptoms) had a two-fold increased likelihood of PRAE compared with children without SDB (52.8% vs 27.9% respectively, LR(+) = 2.00, 95% CI = 1.60-2.49, P = 0.0001). A subset analysis of children undergoing airway procedures requiring hospital admittance (n = 179) showed that those with SDB were given the same postoperative opioid doses as children without SDB. However, children with SDB symptoms generated a greater number of postoperative oxygen desaturation alarms (14.14 ± 29.3 vs 7.12 ± 13.2, mean difference = 7.02, 95% CI = 0.39-13.64, P = 0.038) and more frequently required escalation of care (15.3% vs 7.1%, LR(+) = 1.67, 95% CI = 1.22-2.16, P = 0.001) compared with children with no SDB symptoms.
Conclusions:
Children presenting for surgery with SDB symptoms are at increased risk for PRAE. Children undergoing airway-related procedures also appear to be at increased risk for ORAE. Furthermore, regardless of the preoperative assessment of risk using the STBUR questionnaire, children received the same doses of opioids postoperatively. Given the increased incidence of postoperative oxygen desaturations among children with SDB symptoms, it would seem prudent to consider titration of opioid doses according to identified risk.
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