Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T06:09:59.691Z Has data issue: false hasContentIssue false
  • English
  • Français

Investigating the effect of a nasal decongestant on post-adenotonsillectomy respiratory complications in 25 paediatric patients with obstructive sleep apnoea: a pilot study

Published online by Cambridge University Press:  01 February 2019

E Shamil ,
M J Rouhani ,
A C Panayi ,
J Lynch ,
J Tysome  and
N Jonas
E Shamil*
Affiliation:
ENT Department, Cambridge University Hospitals NHS Foundation Trust, UK Specialist Registrar in Otolaryngology, London Deanery, UK
M J Rouhani
Affiliation:
Specialist Registrar in Otolaryngology, London Deanery, UK School of Clinical Medicine, University of Cambridge, UK
A C Panayi
Affiliation:
School of Clinical Medicine, University of Cambridge, UK
J Lynch
Affiliation:
Anaesthetic Department, Cambridge University Hospitals NHS Foundation Trust, UK
J Tysome
Affiliation:
ENT Department, Cambridge University Hospitals NHS Foundation Trust, UK
N Jonas
Affiliation:
ENT Department, Cambridge University Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Mr Eamon Shamil Specialist Registrar in Otolaryngology, London Deanery, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Adenotonsillectomy is frequently performed for obstructive sleep apnoea, but is associated with post-operative respiratory morbidity. This study assessed the effect of paediatric Otrivine (0.05 per cent xylometazoline hydrochloride) on post-operative respiratory compromise.

Methods

Paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea were included. The control group (n = 24) received no intervention and the intervention group (n = 25) received intra-operative paediatric Otrivine during induction using a nasal patty. Post-operative outcomes included pain, respiratory distress signs and medical intervention level required (simple, intermediate and major).

Results

Post-operative respiratory distress signs were exhibited by 4 per cent of the Otrivine group and 21 per cent of the control group. Sixty-eight per cent of the Otrivine group required simple medical interventions post-operatively, compared to 42 per cent of the control group. In the Otrivine group, 4 per cent required intermediate interventions; none required major interventions. In the control group, 12.5 per cent required both intermediate and major interventions. Fifty per cent of the control group reported pain post-operatively, compared with 40 per cent in the Otrivine group.

Conclusion

Intra-operative paediatric Otrivine may reduce post-operative respiratory compromise in paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea. A randomised controlled trial is required.

Keywords

Sleep Apnea, ObstructiveSleep-Disordered BreathingDecongestants
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 2 , February 2019 , pp. 110 - 114
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr E Shamil takes responsibility for the integrity of the content of the paper

References

1Lumeng, JC, Chervin, RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 2008;5:242–52Google Scholar
2Marcus, CL, Brooks, LJ, Draper, KA, Gozal, D, Halbower, AC, Jones, J et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130:714–55Google Scholar
3Suen, JS, Arnold, JE, Brooks, LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995;121:525–30Google Scholar
4Lim, J, McKean, M. Adenotonsillectomy for obstructive sleep apnea in children. Cochrane Database Syst Rev 2003;(4):CD003136Google Scholar
5Richmond, KH, Wetmore, RF, Baranak, CC. Postoperative complications following tonsillectomy and adenoidectomy–who is at risk? Int J Pediatr Otorhinolaryngol 1987;13:117–24Google Scholar
6McColley, SA, April, MM, Carroll, JZ, Naclerio, RM, Loughlin, GM. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992;118:940–3Google Scholar
7Wilson, K, Lakheeram, I, Morielli, A, Brouillette, R, Brown, K. Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology 2001;96:313–22Google Scholar
8Eskiizmir, G, Hirçin, Z, Ozyurt, B, Unlü, H. A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects. Eur J Clin Pharmacol 2011;67:19–23Google Scholar
9Chung, F, Liao, P, Yegneswaran, B, Shapiro, CM, Kang, W. Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology 2014;120:287–98Google Scholar
10Marcus, CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol 2000;119:143–54Google Scholar
11De Luca Canto, G, Pachêco-Pereira, C, Aydinoz, S, Bhattacharjee, R, Tan, HL, Kheirandish-Gozal, L et al. Adenotonsillectomy complications: a meta-analysis. Pediatrics 2015;136:702–18Google Scholar
12Sanders, JC, King, MA, Mitchell, RB, Kelly, JP. Perioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome. Anesth Analg 2006;103:1115–21Google Scholar
13Clarenbach, CF, Kohler, M, Senn, O, Thurnheer, R, Bloch, KE. Does nasal decongestion improve obstructive sleep apnea? J Sleep Res 2008;17:444–9Google Scholar
14El-Seify, ZA, Khattab, AM, Shaaban, AA, Metwalli, OS, Hassan, HE, Ajjoub, LF. Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery. Br J Anaesth 2010;105:501–5Google Scholar
15McCluney, NA, Eng, CY, Lee, MS, McClymont, LG. A comparison of xylometazoline (Otrivine) and phenylephrine/lignocaine mixture (Cophenylcaine) for the purposes of rigid nasendoscopy: a prospective, double-blind, randomised trial. J Laryngol Otol 2009;123:626–30Google Scholar