Selected risk factors in pediatric adenotonsillectomy
M. E. Gerber, D. M. O'Connor, E. Adler and C. M. Myer 3rd
Department of Pediatric Otolaryngology, University of Cincinnati, Children's Hospital Medical Center, Ohio, USA.
OBJECTIVE: To evaluate the ability of a set of cost-effective criteria to
identify before surgery the pediatric patients in whom perioperative
respiratory compromise is most likely to develop after adenotonsillectomy.
SETTING: A children's hospital medical center. DESIGN: Prospective study
using preoperative parental questionnaires and perioperative respiratory
status documentation. PATIENTS: All patients scheduled at the outpatient
clinic were eligible. MAIN OUTCOME MEASURE: The development of respiratory
compromise as defined by at least 1 of the following occurring more than 2
hours after surgery: an oxygen desaturation level of less than 90%, an
obstructive breathing pattern, or respiratory distress requiring
intervention. RESULTS: The risk of respiratory compromise was significantly
increased in patients who were younger than 3 years (P < .001) and in
those who had neuromuscular disorders (P < .05), chromosomal
abnormalities (P < .005), difficulty in breathing during sleep (P <
.005), restless sleep (P < .01), loud snoring with apnea (P < .05),
or an upper respiratory tract infection within 4 weeks of surgery (P =
.005). Respiratory compromise did not develop in any patients who did not
snore (P < .05). CONCLUSIONS: A complete history that includes symptoms
suggestive of sleep apnea will assist in the preoperative identification of
pediatric patients most at risk for perioperative respiratory compromise
after undergoing adenotonsillectomy. Such patients might benefit from
overnight observation in a hospital setting. However, when snoring is
absent, outpatient surgery is appropriate, as the risk of respiratory
compromise is minimal.
