Abstract
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.
Highlights
In 2006, the American Society of Anesthesiologists (ASA) published the guidelines for the perioperative management of patients with obstructive sleep apnea (OSA) with special emphasis on risk factors like obesity and age under 3 years [1]
In 2014, the ASA guidelines update report recommended that patients under 3 years, with severe OSA (AHI >10/h) or NADIR
Statistical significance was found between the presence of respiratory complications and a preoperative Apnea Hypopnea Index (AHI) greater than or equal to 44/h, p < 0.04 (95% confidence interval (CI): (-28.91) - (0.62))
Summary
In 2006, the American Society of Anesthesiologists (ASA) published the guidelines for the perioperative management of patients with OSA with special emphasis on risk factors like obesity and age under 3 years [1]. In 2012 the American Academy of Pediatrics published guidelines with recommendations on the intrahospital postoperative care of patients with severe OSA (AHI>24/H, NADIR 60 mmHg in PSG), children under 3 years, and children with severe comorbidities or obesity [3]. In 2014, the ASA guidelines update report recommended that patients under 3 years, with severe OSA (AHI >10/h) or NADIR
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