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

Autor: Marrugo Pardo G; Titular Professor, Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, Colombia.; Chief of Pediatric Otolaryngology Department, Fundación Hospital de la Misericordia, Bogotá, Colombia., Romero Moreno LF; Department of Otorhinolarynglogy, Universidad Nacional de Colombia, Bogotá, Colombia., Beltrán Erazo P; Department of Otorhinolarynglogy, Universidad Nacional de Colombia, Bogotá, Colombia., Villalobos Aguirre C; Department of Otorhinolarynglogy, Universidad Nacional de Colombia, Bogotá, Colombia.
Jazyk: angličtina
Zdroj: Sleep disorders [Sleep Disord] 2018 Nov 01; Vol. 2018, pp. 1968985. Date of Electronic Publication: 2018 Nov 01 (Print Publication: 2018).
DOI: 10.1155/2018/1968985
Abstrakt: 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.
Databáze: MEDLINE
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