Is routine pre-operative cardiac evaluation necessary in obese children undergoing adenotonsillectomy for OSA?

Autor: Larrier DR; Division of Pediatric Otolaryngology, Texas Children's Hospital, Bobby Alford Department of Otolaryngology, Baylor College of Medicine, 6701 Fannin St., Suite 640, Houston, TX, USA. Electronic address: drlarrie@texaschildrens.org., Huang ZJ; Bobby Alford Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA., Zhang W; Texas Children's Hospital Outcomes and Impact Service, Texas Children's Hospital, Houston, TX, USA., McHugh CH; Omaha, NE, USA., Brock L; Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA; Department of Surgery, Texas Children's Hospital, Houston, TX, USA., Reddy SC; Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2015 Nov-Dec; Vol. 36 (6), pp. 744-7. Date of Electronic Publication: 2015 Jun 10.
DOI: 10.1016/j.amjoto.2015.05.007
Abstrakt: Background: Adenotonsillectomy (T&A) is a common surgery performed for obstructive sleep apnea (OSA) in children. Obese children are at increased risk for OSA, but are also at increased risk for cardiovascular changes that might heighten their risk of undergoing a general anesthetic. There is currently no standard of care recommendation for cardiac workup prior to T&A.
Purpose: To ascertain whether a preoperative cardiac workup is predictive of postoperative complications in obese children undergoing T&A for OSA.
Design: Retrospective cohort review.
Material and Methods: 241 children with BMI ≥ 25 kg/m(2) underwent T&A for OSA. This cohort was divided into three groups - those who had no preoperative cardiac evaluation, those who had a preoperative cardiac evaluation but no significant findings and those who had a preoperative cardiac evaluation with at least one significant finding. Postoperative cardiac-related complications were compared between the three groups.
Results: There were significantly more postoperative complications in Group 3, the group with findings on preoperative cardiac evaluation. However, these were heavily weighted toward "hospital stay > 24 hours" without clear cardiac sequelae. Notably there were no incidents of pulmonary edema, re-intubation postoperatively or death.
Conclusion: In obese children undergoing T&A at a tertiary care center, a preoperative cardiac workup was not shown to be beneficial in predicting postoperative complications.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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