Canadian Journal of Anesthesia

, Volume 51, Issue 1, pp 62–67

Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon

  • Albert Koomson
  • Isabelle Morin
  • Robert Brouillette
  • Karen A. Brown
Obstetrical and Pediatrie Anesthesia

Abstract

Purpose

To determine, in a subset of children previously reported, if the time of day when adenotonsillectomy for severe obstructive sleep apnea syndrome (OSAS) was performed affected the incidence of postoperative respiratory complications.

Clinical features

Children having adenotonsillectomy were included if they had a polysomnographic diagnosis of severe OSAS within six months prior to operation. Patients who met the inclusion criteria were grouped by the occurrence of postoperative desaturation into a saturated (SAT) and desaturated (deSAT) group. The charts of children in group deSAT were reviewed. The clock time of the surgical procedure was recorded and categorized as morning (AM) or afternoon (PM).

Results

Eighty-eight patients met the inclusion criteria. There were 31 girls and 57 boys. The mean ± SD age (yr) and weight (kg) were 4.6 ± 2.9 yr and 20.8 ± 14.5 kg respectively. There were 63 children in the SATgroup and 25 in the deSATgroup. Differences in age, weight and gender were not significant. The preoperative oxygen saturation (SaO2) nadir for the SAT and deSAT groups was 80.8 ± 10.2% and 67.6 ± 17.5% (P < 0.05) respectively. The preoperative obstructive apnea and hypopnea index was 15.8 ± 10.2 and 35.7 ± 34.6 events · hr−1 (P < 0.05), respectively. Surgery in 63 (71.6%) children was performed in the AM. Univariate logistic regression identified PM surgery [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.7 to 12.6,P = 0.002] and a preoperative SaO2 nadir < 80% (OR 3.6, 95% CI 1.4 to 9.4,P = 0.009) as risk factors predicting postadenotonsillectomy desaturation.

Conclusion

Children with severe OSAS whose surgery is performed in the AM are less likely to desaturate following adenotonsillectomy than children whose surgery is performed in the PM.

Les enfants atteints d’un SAOS sévere, opérés pour amygdalectomie le matin, sont moins susceptibles de désaturation postopératoire que les opérés d’après-midi

Résumé

Objectif

Déterminer, chez un sous-groupe connu d’enfants, si i’heure à iaqueiie i’amygdaiectomie a été réalisée pour un syndrome sévère d’apnée obstructive du sommeil (SAOS) a un effet sur l’incidence de complications respiratoires postopératoires.

Éléments cliniques

Des enfants subissant une amygdalectomie ont été inclus dans notre étude si un diagnostic polysomnographique de SAOS sévère avait été établi dans les six mois avant l’opération. Les patients admis ont été répartis selon l’occurrence de désaturation postopératoire dans un groupe de saturation (SAT) ou de désaturation (deSAT). Les dossiers des enfants du groupe deSAT ont été révisés. L’heure de l’opération a été notée sous matin (AM) ou après-midi (PM).

Résultats

Ont été admis à l’étude, 88 patients dont 31 files et 57 garçons. La moyenne d’âge et de poids ± l’écart type étaient respectivementde 4,6 ± 2,9 ans et 20,8 ± 14,5 kg. Il y a eu 63 enfants dans le groupe SAT et 25 dans le groupe deSAT. Les différences d’âge, de poids et de sexe n’étaient pas signifcatives. Le niveau préopératoire minimal de saturation en oxygène (SaO2) a été de 80,8 ± 10,2 % et de 67,6 ± 17,5 % (P < 0,05) dans les groupes SAT et deSAT respectivement. Les indices d’apnée obstructive et d’hypopnée préopératoires étaient de 15,8 ± 10,2 et de 35,7 ± 34,6 événements · h−1 (P < 0,05), respectivement. L’opération de 63 (71,6 %) enfants s’est faite en AM. Une analyse univariée de régression logistique a considéré l’opération réalisée en PM [risque relatif (RR) de 4,6, intervalle de confiance (IC) de 95 %, 1,7 à 12,6, P = 0,002] et un niveau minimal de SaO2 préopératoire < 80 % (RR de 3,6, IC de 95 %, 1,4 à 9,4, P = 0,009) comme des facteurs de risque prédictifs de désaturation postamygdalectomie.

Conclusion

Les enfants atteints d’un SAOS sévère, opérés en AM, sont moins susceptibles de subir une désaturation postamygdalectomie que les enfants opérés en PM.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Albert Koomson
    • 1
  • Isabelle Morin
    • 3
  • Robert Brouillette
    • 2
  • Karen A. Brown
    • 1
  1. 1.Department of AnesthesiaMontreal Children’s HospitalCanada
  2. 2.Department of PediatricsMontreal Children’s HospitalCanada
  3. 3.Biostatistics LaboratoryMcGill University Health Centre Research InstituteMontrealCanada
  4. 4.Division of Pediatrie AnesthesiaMcGill University Health Centre/Montreal Children’s HospitalMontrealCanada

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