Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-22T19:35:35.908Z Has data issue: false hasContentIssue false

Pre-operative overnight pulse oximetry to predict high dependency unit intervention in children undergoing adenotonsillectomy for obstructive sleep apnoea

Published online by Cambridge University Press:  15 April 2014

K A Lightbody*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Countess of Chester Hospital NHS Foundation Trust, Countess of Chester Health Park, Chester, UK
A J Kinshuck
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Alder Hey Children's NHS Foundation Trust, Alder Hey Hospital, Liverpool, UK
A J Donne
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Alder Hey Children's NHS Foundation Trust, Alder Hey Hospital, Liverpool, UK
*
Address for correspondence: Ms K A Lightbody, Apartment 26, 3 St Paul's Square, Liverpool L3 9RY, UK E-mail: [email protected]

Abstract

Background:

Post-operative high dependency unit beds are often requested for patients undergoing adenotonsillectomy for obstructive sleep apnoea. This study evaluated the utilisation of high dependency unit beds for such cases at our institution, a paediatric tertiary referral centre.

Method:

A retrospective case note review of patients admitted to the high dependency unit following adenotonsillar surgery for obstructive sleep apnoea, over a two-year period, was performed.

Results:

Sixty-six cases were identified. Thirty-nine patients underwent pre-operative overnight pulse oximetry; of these, 30 patients had desaturations noted. Seventeen patients had significant post-operative desaturations. These were predicted in all 11 patients who had undergone pre-operative pulse oximetry. The remaining six had not undergone pre-operative pulse oximetry. Nineteen patients required high dependency unit care; eight had experienced post-operative desaturations.

Conclusion:

High dependency unit care may be required following adenotonsillectomy for obstructive sleep apnoea. In this study, pre-operative overnight pulse oximetry had 100 per cent sensitivity in predicting post-operative desaturations, and may therefore aid the appropriate utilisation of high dependency unit beds for patients undergoing adenotonsillectomy for obstructive sleep apnoea.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2014 

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.)

References

1Robb, PJ, Bew, S, Kubba, H, Murphy, N, Primhak, R, Rollin, A-M et al. Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party. Ann R Coll Surg Engl 2009;91:371–3CrossRefGoogle ScholarPubMed
2Schwengel, D, Sterni, L, Tunkel, D, Heitmiller, E. Perioperative management of children with obstructive sleep apnoea. Anesth Analg 2009;109:6075CrossRefGoogle Scholar
3Anuntaseree, W, Rookkapan, K, Kuasirikul, S, Thongsuksai, P. Snoring and obstructive sleep apnoea in Thai school-age children: prevalence and predisposing factors. Pediatr Pulmonol 2001;32:222–7Google Scholar
4Brunetti, L, Rana, S, Lospalluti, ML, Pietrafesa, A, Francavilla, R, Fanelli, M et al. Prevalence of obstructive sleep apnoea syndrome in a cohort of 1,207 children of southern Italy. Chest 2001;120:1930–5Google Scholar
5Mitchell, R. Adenotonsillectomy for obstructive sleep apnoea in children: outcome evaluated by pre- and post-operative polysomnography. Laryngoscope 2007;117:1844–54Google Scholar
6Indications for tonsillectomy: ENT UK position paper 2009. In: https://entuk.org/docs/prof/position_papers/tonsillectomy_position_paper [10 March 2014]Google Scholar
7Randhawa, PS, Cetto, R, Chilvers, G, Geogalas, C, Narula, AA. Long-term quality-of-life outcomes in children undergoing adenotonsillectomy for obstructive sleep apnoea: a longitudinal study. Clin Otolaryngol 2001;36:475–81Google Scholar
8Statham, MM, Elluru, RG, Buncher, R, Kalra, M. Adenotonsillectomy for obstructive sleep apnea syndrome in young children: prevalence of pulmonary complications. Arch Otolaryngol Head Neck Surg 2006;132:476–80CrossRefGoogle ScholarPubMed
9Schechter, MS. Technical report: diagnosis and management of childhood obstructive sleep apnoea syndrome. Pediatrics 2002;109:e69CrossRefGoogle Scholar
10Rosen, GM, Muckle, RP, Goding, GS, Mahowald, MW, Ullevig, C. Postoperative respiratory compromise in children with obstructive sleep apnoea syndrome: can it be anticipated? Pediatrics 1994;93:784–8Google Scholar
11Brouillette, RT, Morielli, A, Laemanis, A, Waters, K, Luciano, R, Ducharme, FM. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Paediatrics 2000;105:405–12Google Scholar
12Nixon, GM, Kermack, AS, Davis, GM, Manoukian, JJ, Brown, KA, Brouillette, RT et al. Planning adenotonsillectomy in children with obstructive sleep apnoea: the role of overnight oximetry. Pediatrics 2004;113:e19CrossRefGoogle ScholarPubMed
13Blenke, EJSM, Anderson, AR, Raja, H, Bew, S, Knight, LC. Obstructive sleep apnoea adenotonsillectomy in children: when to refer to a centre with a paediatric intensive care unit? J Laryngol Otol 2008;122:42–5CrossRefGoogle ScholarPubMed
14Rieder, A, Flanary, V. The effect of polysomnography on pediatric adenotonsillectomy postoperative management. Otolaryngol Head Neck Surg 2005;132:263–7CrossRefGoogle ScholarPubMed
15Wilson, K, Lakheeram, I, Morielli, A, Brouillette, RT, Brown, KA. Can assessment for obstructive sleep apnoea help predict postadenotonsillectomy respiratory complications? Anesthesiology 2002;96:313–22Google Scholar
16Walker, P, Whitehead, B, Rowley, M. Criteria for elective admission to the paediatric intensive care unit following adenotonsillectomy for severe obstructive sleep apnoea. Anaesth Intensive Care 2004;32:43–6Google Scholar
17Tweedie, DJ, Skilbeck, CJ, Lloyd-Thomas, AR, Albert, DM. The nasopharyngeal prong airway: an effective post-operative adjunct after adenotonsillectomy for obstructive sleep apnoea in children. Int J Pediatr Otorhinolaryngol 2007;71:563–9Google Scholar
18Tweedie, DJ, Bajaj, Y, Ifeacho, SN, Lloyd-Thomas, AR, Albert, DM. Use of a post-operative nasopharyngeal prong airway after adenotonsillectomy in children with obstructive sleep apnoea: how we do it. Clin Otolaryngol 2011;36:575–87Google Scholar