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Predicting Perioperative Respiratory Adverse Events in Children With Sleep-Disordered Breathing
Carolyne Pehora1, David Faraoni1,2, Soichiro Obara3
1From the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Perioperative respiratory adverse events (PRAEs) occurred in 5.6% of anesthesia encounters in children with sleep-disordered breathing (SDB). Risk factors include positive airway pressure treatment, outpatient procedures, severe SDB, preoperative oxygen, prematurity, and endotracheal intubation.
Area of Science:
- Anesthesiology
- Pediatrics
- Respiratory Medicine
Background:
- Limited data exists on perioperative respiratory adverse events (PRAEs) in pediatric patients with sleep-disordered breathing (SDB).
- Quantifying PRAE risk and incidence in this population undergoing general anesthesia is crucial.
Purpose of the Study:
- To determine the incidence of PRAEs in children with polysomnography-confirmed SDB undergoing general anesthesia.
- To identify risk factors associated with PRAEs in this patient group.
Main Methods:
- Retrospective review of 771 anesthesia encounters in 393 patients with SDB from 2009-2013.
- Comparison of demographic and perioperative variables between patients with and without PRAEs.
- Development of a predictive model for PRAEs using generalized estimating equations.
Main Results:
- A total of 51 PRAEs occurred in 43 (5.6%) of the 771 anesthesia encounters.
- Significant risk factors for PRAEs included positive airway pressure therapy, outpatient procedures, severe SDB, preoperative oxygen use, prematurity history, and endotracheal intubation.
- Continuous positive airway pressure or bilevel positive airway pressure (OR, 1.63), outpatient procedures (OR, 1.37), severe obstructive sleep apnea (OR, 1.63), preoperative oxygen (OR, 1.82), prematurity (OR, 2.31), and endotracheal intubation (OR, 3.03) were associated with PRAEs.
Conclusions:
- Identified risk factors can inform a preoperative risk assessment tool for PRAEs in pediatric SDB patients.
- Further validation of this model can improve risk stratification, decision-making for postoperative care, and resource allocation.
- This study provides valuable insights for managing pediatric patients with SDB undergoing anesthesia.
Background:
No evidence currently exists to quantify the risk and incidence of perioperative respiratory adverse events (PRAEs) in children with sleep-disordered breathing (SDB) undergoing all procedures requiring general anesthesia. Our objective was to determine the incidence of PRAEs and the risk factors in children with polysomnography-confirmed SDB undergoing procedures requiring general anesthesia.
Methods:
Retrospective review of all patients with polysomnography-confirmed SDB undergoing general anesthesia from January 2009 to December 2013. Demographic and perioperative outcome variables were compared between children who experienced PRAEs and those who did not. Generalized estimating equations were used to build a predictive model of PRAEs.
Results:
In a cohort of 393 patients, 51 PRAEs occurred during 43 (5.6%) of 771 anesthesia encounters. Using generalized estimating equations, treatment with continuous positive airway pressure or bilevel positive airway pressure (odds ratio, 1.63; 95% confidence interval [CI], 1.05-2.54; P = .031), outpatient (odds ratio, 1.37; 95% CI, 1.03-1.91; P = .047), presence of severe obstructive sleep apnea (odds ratio, 1.63; 95% CI, 1.09-2.42; P = .016), use of preoperative oxygen (odds ratio 1.82; 95% CI, 1.11-2.97; P = .017), history of prematurity (odds ratio, 2.31; 95% CI, 1.33-4.01; P = .003), and intraoperative airway management with endotracheal intubation (odds ratio, 3.03; 95% CI, 1.79-5.14; P < .001) were associated with PRAEs.
Conclusions:
We propose the risk factors identified within this cohort of SDB patients could be incorporated into a preoperative risk assessment tool that might better to identify the risk of PRAE during general anesthesia. Further investigation and validation of this model could contribute to improved preoperative risk stratification, decision-making (postoperative admission and level of monitoring), and health care resource allocation.
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