Pre-operative overnight pulse oximetry to predict high dependency unit intervention in children undergoing adenotonsillectomy for obstructive sleep apnoea

2014 ◽  
Vol 128 (4) ◽  
pp. 360-364 ◽  
Author(s):  
K A Lightbody ◽  
A J Kinshuck ◽  
A J Donne
Keyword(s):  
Pulse Oximetry ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
High Dependency Unit ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
High Dependency ◽  
Obstructive Sleep ◽  
Case Note Review

AbstractBackground:Post-operative high dependency unit beds are often requested for patients undergoing adenotonsillectomy for obstructive sleep apnoea. This study evaluated the utilisation of high dependency unit beds for such cases at our institution, a paediatric tertiary referral centre.Method:A retrospective case note review of patients admitted to the high dependency unit following adenotonsillar surgery for obstructive sleep apnoea, over a two-year period, was performed.Results:Sixty-six cases were identified. Thirty-nine patients underwent pre-operative overnight pulse oximetry; of these, 30 patients had desaturations noted. Seventeen patients had significant post-operative desaturations. These were predicted in all 11 patients who had undergone pre-operative pulse oximetry. The remaining six had not undergone pre-operative pulse oximetry. Nineteen patients required high dependency unit care; eight had experienced post-operative desaturations.Conclusion:High dependency unit care may be required following adenotonsillectomy for obstructive sleep apnoea. In this study, pre-operative overnight pulse oximetry had 100 per cent sensitivity in predicting post-operative desaturations, and may therefore aid the appropriate utilisation of high dependency unit beds for patients undergoing adenotonsillectomy for obstructive sleep apnoea.

Multinodular thyroid goitre causing obstructive sleep apnoea syndrome

2011 ◽  
Vol 126 (2) ◽  
pp. 190-195 ◽  
Author(s):  
T Gutierrez ◽  
A C Leong ◽  
L Pang ◽  
E Chevretton ◽  
J-P Jeannon ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Obstructive Sleep Apnoea ◽  
Case Series ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Retrospective Case ◽  
Adenotonsillar Hypertrophy ◽  
Sleep Apnoea Syndrome ◽  
Obstructive Sleep ◽  
Thyroid Goitre

AbstractBackground:Obstructive sleep apnoea syndrome has been linked to obesity, nasal obstruction and adenotonsillar hypertrophy, but rarely to large thyroid goitres.Objective:To study the possible association between multinodular retrolaryngo-pharyngeal or retrosternal goitres and obstructive sleep apnoea syndrome.Subjects and methods:Retrospective case series at a tertiary referral centre (2000–2010). Study parameters included body mass index, Epworth sleep score and polysomnographic index.Results:Five patients were diagnosed with obstructive sleep apnoea syndrome and managed with nasal continuous positive airway pressure ventilation. Computed tomography showed a retrolaryngo-pharyngeal or retrosternal goitre with significant tracheal compression, displacement and laryngeal oedema. After total thyroidectomy, obstructive sleep apnoea resolved in all patients.Conclusion:Large, multinodular goitres with retrolaryngo-pharyngeal extension can cause obstructive sleep apnoea syndrome due to laryngeal compression and oedema. In such cases, total thyroidectomy enables resolution of symptoms. Patients with obstructive sleep apnoea syndrome should be screened for thyroid goitre.

scholarly journals Obstetric patients requiring high-dependency unit admission in a tertiary referral centre

2013 ◽  
Vol 3 (1) ◽  
pp. 31 ◽  
Author(s):  
Debasmita Mandal ◽  
Uma Shankar ◽  
Partha Bhattacharya ◽  
Saroj Mandal ◽  
Chaitalli Dattaray
Keyword(s):  
High Dependency Unit ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
High Dependency

Maturation sutures for the paediatric tracheostomy – an extra safety measure

2005 ◽  
Vol 119 (12) ◽  
pp. 985-987 ◽  
Author(s):  
M F Craig ◽  
Y Bajaj ◽  
B E J Hartley
Keyword(s):  
Late Complications ◽  
Case Note ◽  
Safety Measure ◽  
Complication Rates ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Fatal Complication ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Case Note Review

Objective: Displacement of the tracheostomy tube in paediatric patients is a potentially fatal complication. We describe an extra safety measure which facilitates tube replacement.Setting: Tertiary referral specialist paediatric centre.Materials and methods: The method involves the placement of sutures between the anterior tracheal wall and skin to hasten the formation of a mature stoma (maturation sutures). We also undertook a retrospective case note review on patients from an academic tertiary referral centre. Thirty-five notes were reviewed. The most common indication for tracheostomy was airway obstruction (65 per cent). Fourteen patients had early and 10 had late complications with three tube displacements occurring. No added complications due to the use of sutures were found.Conclusions: Our complication rates compare well with those in the literature, and we recommend considering the use of such a technique.

scholarly journals Use of oximetry to screen for paediatric obstructive sleep apnoea: is one night enough and is 6 hours too much?

2020 ◽  
Vol 106 (1) ◽  
pp. 58-61
Author(s):  
Niamh Catherine Galway ◽  
Barbara Maxwell ◽  
Michael Shields ◽  
Dara O'Donoghue
Keyword(s):  
Retrospective Study ◽  
Pulse Oximetry ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Time Threshold ◽  
Paediatric Patients ◽  
Moderate Agreement ◽  
Obstructive Sleep ◽  
The Impact ◽  
Nocturnal Oximetry

IntroductionNocturnal pulse oximetry can be used to screen for obstructive sleep apnoea (OSA) using the McGill Oximetry Score (MOS). The MOS has a time threshold for a technically adequate study of 6 hours. It has been suggested that one night of oximetry is sufficient to screen for OSA using the MOS.Aims(1) To evaluate night-to-night variation of the MOS. (2) To determine the impact of recording three nights of oximetry on the screening yield for OSA. (3) To explore whether useful MOS data are discarded when a threshold of 6 hours of oximetry recording is used.MethodsA retrospective study of nocturnal pulse oximetry done at home over three consecutive nights in paediatric patients with suspected OSA. Studies were scored (MOS) using thresholds of ≥6 and ≥4 hours of recording.ResultsA total of 329 patients were studied. MOS scores over three nights showed only fair to moderate agreement. On the first night 126 patients (38%) screened positive for OSA. When three nights of oximetry were done 195 patients (59%) screened positive on at least one of the nights. There were 48 patients with studies of between 4 and 6 hours duration on one or more nights. If these studies are scored 20 patients (42%) would screen positive for OSA on at least one night based on scoring these studies alone.ConclusionOne night of oximetry screening may not be sufficient to screen for OSA. Lowering the time threshold to ≥4 hours may increase the screening capability of nocturnal oximetry.

Pulse oximetry in paediatric obstructive sleep apnoea: is it used appropriately?

2015 ◽  
Vol 129 (9) ◽  
pp. 874-881 ◽  
Author(s):  
H Kanona ◽  
S Sharma ◽  
K Chaidas ◽  
B Kotecha
Keyword(s):  
Pulse Oximetry ◽  
Obstructive Sleep Apnoea ◽  
Hospital Setting ◽  
Sleep Apnoea ◽  
Test Results ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Outcome Scores ◽  
Uk National Health Service

AbstractObjectives:This study assessed the use of pulse oximetry testing in children with suspected obstructive sleep apnoea in a hospital setting.Methods:A retrospective review of patients who underwent pulse oximetry testing between April 2013 and October 2013 was performed. Primary outcome measures included positive pulse oximetry results, defined as a McGill oximetry score of 2–4.Results:Thirty-seven test results were usable for analysis: from 21 pre- and 16 post-operative tests. Only four patients had positive test results. There was a significant difference between pre- and post-operative quality of life outcome scores in the surgical group (p < 0.0001).Conclusion:Pre-operative pulse oximetry should be used as a guide to help triage patients who require specialist paediatric services, such as a paediatric intensive care unit. The use of pulse oximetry, particularly in the post-operative setting, is unlikely to change patient management and can incur unnecessary financial costs to UK National Health Service Hospital Trusts.

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