Urgent Adenotonsillectomy

2003 ◽  
Vol 99 (3) ◽  
pp. 586-595 ◽  
Author(s):  
Karen A. Brown ◽  
Isabelle Morin ◽  
Chantal Hickey ◽  
John J. Manoukian ◽  
Gillian M. Nixon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Medical Intervention ◽  
Control Group ◽  
Respiratory Complications ◽  
Obstructive Sleep ◽  
Postoperative Respiratory Complications

Background The aim of this study was to determine the frequency and type of respiratory complications after urgent adenotonsillectomy (study group) for comparison with a control group of children undergoing a sleep study and adenotonsillectomy for obstructive sleep apnea syndrome. A second aim was to assess risk factors predictive of respiratory complications after urgent adenotonsillectomy. Methods The perioperative course of children who underwent adenotonsillectomy between January 1, 1999, and March 31, 2001, was reviewed. Two groups of children were identified from two different databases: the hospital database for surgical procedures (the study group) and the sleep laboratory database (the control group). The retrospective chart review focused on the preoperative status (including an evaluation for obstructive sleep apnea), anesthetic management, and need for postoperative respiratory interventions. Results A total of 64 consecutive cases for urgent adenotonsillectomy were identified, and 54 children met the inclusion criteria. Thirty-three children (60%) had postoperative respiratory complications necessitating a medical intervention; 11 (20.3%) required a major intervention (reintubation, ventilation, and/or administration of racemic epinephrine or Ventolin), and 22 (40.7%) required a minor intervention (oxygen administration). Six children (11.1%) required reintubation in the recovery room for respiratory compromise. Risk factors for respiratory complications were an associated medical condition (odds ratio, 8.15; 95% confidence interval, 1.81-36.73) and a preoperative saturation nadir less than 80% (odds ratio, 5.54; 95% confidence interval, 1.15-26.72). Sixteen (49%) of the medical interventions were required within the first postoperative hour. Atropine administration, at induction, decreased the risk of postoperative respiratory complications (odds ratio, 0.18; 95% confidence interval, 0.11-1.050. Control Group Of 75 children who underwent a sleep study and adenotonsillectomy, 44 had sleep apnea and were admitted to hospital after elective adenotonsillectomy. Sixteen (36.4%) children had postoperative respiratory complications necessitating a medical intervention. Six percent of the children (n = 3) required a major medical intervention. No child required reintubation for respiratory compromise. Conclusions Severe obstructive sleep apnea syndrome and an associated medical condition are risk factors for postadenotonsillectomy respiratory complications. Risk reductions strategies should focus on their assessment.

scholarly journals Respiratory Complications of Adenotonsillectomy for Obstructive Sleep Apnea in the Pediatric Population

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
G. Marrugo Pardo ◽  
L. F. Romero Moreno ◽  
P. Beltrán Erazo ◽  
C. Villalobos Aguirre
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pediatric Population ◽  
Early Postoperative Period ◽  
Respiratory Complication ◽  
Apnea Hypopnea Index ◽  
Respiratory Complications ◽  
Obstructive Sleep ◽  
Postoperative Respiratory Complications ◽  
Postanesthetic Care Unit

Objective. To determine the prevalence of respiratory complications in the early postoperative period of children with sleep apnea who required adenotonsillectomy at a tertiary pediatric hospital and to establish recommendations for postoperative monitoring. Methods. Retrospective cohort study of children with obstructive sleep apnea (OSA) diagnosed by polysomnogram (PSG), who underwent adenotonsillectomy for treatment of OSA. The prevalence of respiratory complications in the first 24 postoperative hours was measured. Patients with craniofacial malformations, obesity, and severe cardiovascular comorbidities were excluded. The prevalence of postoperative respiratory complications was compared with the severity of OSA according to the Apnea Hypopnea Index (AHI) and NADIR. All data were taken in patients residing in Bogotá city, Colombia, at 2.640 meters above sea level (m.a.s.l). Results. Between May 2014 and February 2017, 167 patients (108 males) required adenotonsillectomy for OSA, with an age range of 1 and 15 years (mean 5.3 years +/- 2.7). The prevalence of postoperative respiratory complications was 3.59% (6/167). There was a statistically significant relationship between the presence of respiratory complication and AHI greater than 44/h (p <0.04). There was an inverse correlation between the AHI and NADIR values. Risk groups of patients younger than 3 years and NADIR less than 70% had a higher prevalence of respiratory complications; however, this correlation was not statistically significant (p <0.08 and 0.89, respectively). Conclusions. The prevalence of respiratory complications in OSA patients undergoing adenotonsillectomy in high altitudes is similar to that reported in other heights. Preoperative AHI greater than 44/h could be considered a risk factor for early respiratory complication. We suggest ambulatory management after 6 hours in Postanesthetic Care Unit (PACU) observation in patients older than 3 years, with AHI less than 44/h and NADIR greater than 70% in altitudes higher than 2.500 m.a.s.l. Further research must be done to confirm this hypothesis.

scholarly journals Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea

2015 ◽  
Vol 41 (3) ◽  
pp. 238-245 ◽  
Author(s):  
Renato Oliveira Martins ◽  
Nuria Castello-Branco ◽  
Jefferson Luis de Barros ◽  
Silke Anna Theresa Weber
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Teaching Hospital ◽  
Orotracheal Intubation ◽  
Apnea Hypopnea Index ◽  
Respiratory Complications ◽  
Cross Sectional ◽  
Historical Cohort ◽  
Obstructive Sleep

Objective: To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU). Methods: A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors. Results: Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3 ± 2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea). Conclusions: Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.

scholarly journals Az alvási apnoe szindróma vezető rizikótényezőinek esélyhányadosai

2017 ◽  
Vol 158 (21) ◽  
pp. 823-828
Author(s):  
Krisztina Szabó ◽  
Ferenc Ihász
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Odds Ratio ◽  
Sleep Apnea Syndrome ◽  
Test Group ◽  
Obstructive Sleep ◽  
Serious Disease ◽  
Screening Device

Abstract: Introduction: The quality of sleep plays a serious role in the individual’s daytime performace and state of health, there by it has a strong influence on the society. Aim: The present study measures the probability developing and severity of obstructive sleep apnea syndrome, – which belongs to group of disorders of the respiratory – through odds ratio of leading risk factors. Method: 127 persons were examined in the test. The sleep structure test data were processed by polysomnographic screening device. Results: The nutritional level of body in mass index (BMI), and the neck circumferences data were recorded in cm. On the basis of the examination the gender as a risk factor it can be said that the odds ratio for men compared to women, more than three times higher of emergence of disease. Conclusions: Men’s chance of the emergence of serious disease is more than four times higher than women’s chance. In the men’s test group the most significant predictor of obstructive sleep apnea amongst the risk factors is the circumference according to odds ratio. In women’s group the leader odds ratio is BMI. More than 50% of test goup don’t report about daytime sleepiness, and this fact draws our attention to the role of risk factors’ odds ratio in selection. Orv Hetil. 2017; 158(21): 823–828.

Can Assessment for Obstructive Sleep Apnea Help Predict Postadenotonsillectomy Respiratory Complications?

2002 ◽  
Vol 96 (2) ◽  
pp. 313-322 ◽  
Author(s):  
Kerryn Wilson ◽  
Indrani Lakheeram ◽  
Angie Morielli ◽  
Robert Brouillette ◽  
Karen Brown
Keyword(s):  
Confidence Interval ◽  
Oxygen Saturation ◽  
Odds Ratio ◽  
Medical Condition ◽  
Respiratory Complications ◽  
Obstructive Apnea ◽  
Sleep Studies ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Postoperative Respiratory Complications

Background The aim of this study was to determine the frequency and type of respiratory complications after adenotonsillectomy in children. A second aim was to assess the ability of preoperative sleep studies to identify children at risk for respiratory complications. Methods Children referred for sleep studies between 1992 and 1998, who underwent adenotonsillectomy within 6 months of the preoperative study, were reviewed. The study focused on two variables: the obstructive apnea and hypopnea index and the oxygen saturation nadir. Medical charts were reviewed for postoperative respiratory complications. Results Three hundred forty-nine children were referred for sleep studies, and 163 met the inclusion criteria. Thirty-four children (21%) had postoperative respiratory complications requiring a medical intervention. Children experiencing respiratory complications were younger (aged &lt; 2 yr; adjusted odds ratio, 4.3; 95% confidence interval, 1.7-11) and had an associated medical condition (odds ratio, 3; 95% confidence interval, 1.4-6.5). A preoperative obstructive apnea and hypopnea index of 5 or more events per hour increased the chance of postoperative respiratory complications (odds ratio, 7.2; 95% confidence interval, 2.7-19.3), as did a preoperative oxygen saturation nadir of 80% or less (odds ratio, 6.4; 95% confidence interval, 2.8-14.5). A preoperative oxygen saturation nadir of 80% or less had a likelihood ratio of 3.1, increasing the probability of postoperative respiratory complications from 20 to 50%. Conclusions The data suggest, but do not prove, that preoperative nocturnal oximetry could be a useful preoperative test to identify children who are at increased risk for postoperative respiratory complications.

scholarly journals Postoperative Respiratory Complications in Patients at Risk for Obstructive Sleep Apnea

2017 ◽  
Vol 125 (1) ◽  
pp. 272-279 ◽  
Author(s):  
Satya Krishna Ramachandran ◽  
Jaideep Pandit ◽  
Scott Devine ◽  
Aleda Thompson ◽  
Amy Shanks
Keyword(s):  
At Risk ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Respiratory Complications ◽  
Obstructive Sleep ◽  
Patients At Risk ◽  
Postoperative Respiratory Complications
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