Understanding Obstructive Sleep Apnea Syndrome in Children

Abstract

Obstructive sleep apnea syndrome (OSAS) is relevant to pediatric anesthesia and is often encountered in adenotonsillectomy (A&T), the most common pediatric surgery and first-line treatment for OSAS. End-organ effects of OSAS are widespread and include pulmonary and cardiovascular complications, neurocognitive and behavioral disruption, and metabolic and inflammatory derangements. Co-existing obesity and asthma are commonly encountered. OSAS increases risk for postoperative respiratory complications causing death or anoxic brain injury. While preoperative OSAS diagnosis is preferred, anesthesia and surgery societies have not adopted emerging diagnostic technologies. Guidelines for identifying which children may undergo ambulatory versus in-patient surgery, anesthetic technique, and postoperative monitoring are lacking. Risk factors for respiratory complications post A&T include patients <3 years, suspected/diagnosed severe OSAS, and co-morbidities. Perioperative use of NSAIDs in children undergoing A&T remains controversial. Dexamethasone and alpha-2 agonists are preferred in children with OSAS undergoing A&T surgery, whereas neostigmine should be avoided. The ideal opioid for use in these children is unknown. However, prescribing postoperative codeine presents serious risk of perioperative cardiac arrest, particularly in those with severe OSAS complicated by obesity. Opioid metabolic pathway overlap with codeine is a concern. Consensus guidelines are required in pediatric anesthesia to improve outcomes in OSAS.