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Published on: December 6, 2016
Respiratory events after adenotonsillectomy in children with severe obstructive sleep apnea (OSA): A prospective
Proshad N Efune1, Katie Liu2, Paul A Nakonezny3
1University of Texas Southwestern Medical Center, Department of Anesthesiology and Pain Management, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States; Outcomes Research Consortium, Center for Outcomes Research, UT Health, 7000 Fannin St, Ste 160, Houston, TX, 77030, United States.
Insights
Noninvasive respiratory volume monitoring in children with severe obstructive sleep apnea (OSA) after adenotonsillectomy shows promise. Post-anesthesia care unit events may predict subsequent low minute ventilation (MV) events on the ward.
Area of Science:
- Pediatric Anesthesiology
- Sleep Medicine
- Respiratory Physiology
Background:
- Children with severe obstructive sleep apnea (OSA) face significant risks of respiratory complications post-adenotonsillectomy, often requiring overnight observation.
- Assessing the feasibility of noninvasive respiratory volume monitoring (RVM) is crucial for predicting postoperative respiratory events.
Purpose of the Study:
- To evaluate the feasibility of using RVM to monitor postoperative respiratory function in children with severe OSA.
- To determine if RVM can predict low minute ventilation (MV) events during the first postoperative night.
Main Methods:
- A prospective observational study enrolled children under 18 with severe OSA undergoing adenotonsillectomy.
- Noninvasive RVM was used to measure MV, with low MV events defined as predicted MV < 40% for at least 2 minutes.
Main Results:
- The RVM was well-tolerated, with only 8% of patients experiencing intolerance.
- Low MV events occurred in 33% of patients in the postanesthesia care unit (PACU) and 62% on the ward.
- PACU events predicted ward events (OR 4.26), while increasing age was associated with more events, and asthma history was protective.
Conclusions:
- Noninvasive RVM is feasible for monitoring postoperative respiratory function in children with severe OSA.
- Post-anesthesia care unit low MV events may predict subsequent ward events, highlighting a potential early warning sign.
- Further studies are warranted to validate RVM's predictive capability for ventilatory derangements.
Background:
Children with severe obstructive sleep apnea (OSA) are at high risk for respiratory complications following adenotonsillectomy, necessitating overnight observation. We assessed the feasibility of noninvasive respiratory volume monitoring in the postoperative period to predict low minute ventilation (MV) and respiratory events on the first postoperative night.
Methods:
We conducted a prospective observational exploratory study of children under 18 years of age with severe OSA undergoing adenotonsillectomy with planned postoperative admission. The primary outcome was the occurrence of low MV events on the ward, defined as predicted MV < 40% for at least 2 min, measured using a noninvasive respiratory volume monitor (RVM).
Results:
We enrolled 60 children (77% male, median age 6 [4.5] years, 55% non-white, 55% Hispanic, median apnea-hypopnea index 31 [33] events per hour). The RVM sensor was not tolerated overnight in only 5 patients (8%). Low MV events occurred in 33% (19/58) in the postanesthesia care unit (PACU) and 62% (34/55) on the ward. Patients who had PACU events were more likely to have ward events (odds ratio [OR] 4.26; 95% CI 0.98-18.55). Increasing age increased ward events (OR 1.25 per year; 95% CI 1.02-1.52) while history of asthma was protective (OR 0.15; 95% CI 0.02-0.87).
Conclusions:
This exploratory study suggests that PACU low MV events may predict subsequent events on the ward in children with severe OSA undergoing adenotonsillectomy. The RVM demonstrated good feasibility and should be tested in future studies to predict ventilatory derangements on the first postoperative night.
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