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Chronic upper airway obstruction and cardiac dysfunction: anatomy, pathophysiology and anesthetic implications
- Source :
- Paediatric anaesthesia. 14(1)
- Publication Year :
- 2004
-
Abstract
- The causes of obstruction to airflow in the pediatric upper airway include craniofacial disorders, subglottic stenosis, choanal atresia, syndromes associated with neuromuscular weakness, and the most common, hypertrophy of the tonsils and adenoids. Abnormal breathing can adversely affect craniofacial growth, and abnormal craniofacial development can promote upper airway obstruction. Chronic upper airway obstruction often presents with evidence of obstructive sleep apnea syndrome; in severe cases these children also present with pulmonary hypertension and cor pulmonale. The development of pulmonary hypertension and right heart dysfunction from chronic upper airway obstruction is complex. Hypoxemia and hypercarbia-induced respiratory acidosis are potent mediators of pulmonary vasoconstriction that can lead to reversible and irreversible chronic changes in the pulmonary vasculature. It is likely that production of various neurohumoral factors in response to hypoxemia and respiratory distress may further promote pulmonary hypertension, right ventricular dysfunction, and consequent impairment of systemic cardiac output. The anesthetic considerations for children undergoing adenotonsillectomy for chronic airway obstruction are significant. These children are at high risk for complications such as laryngospasm, desaturation, stimulation of pulmonary hypertension and cardiac dysfunction, pulmonary edema, postoperative upper airway obstruction, and respiratory arrest. Because of underlying condition(s) (facial abnormalities, neuromuscular disease, etc.), successful adenotonsillar surgery may not improve upper airway obstruction significantly, especially in the immediate postoperative period when edema, bleeding and the effects of anesthetics and analgesics are present.
- Subjects :
- medicine.medical_specialty
Heart Diseases
Subglottic stenosis
Respiratory arrest
Hypoxemia
Internal medicine
medicine
Humans
Anesthesia
Child
business.industry
respiratory system
Airway obstruction
Pulmonary edema
medicine.disease
Pulmonary hypertension
respiratory tract diseases
Obstructive sleep apnea
Airway Obstruction
Anesthesiology and Pain Medicine
Heart failure
Pediatrics, Perinatology and Child Health
Chronic Disease
Cardiology
medicine.symptom
business
Anesthesia, Inhalation
Subjects
Details
- ISSN :
- 11555645
- Volume :
- 14
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Paediatric anaesthesia
- Accession number :
- edsair.doi.dedup.....ce28aeed40891f976324d93711ec6e43