Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated?

Children with obstructive sleep apnea syndrome (OSAS) who exhibit a high-risk profile and who undergo a tonsillectomy or adenoidectomy should be monitored before and after surgery for upper airway obstruction, according to a study of 312 children. Criteria for the high-risk profile included age less than two years, face and head abnormalities, failure to thrive, abnormal muscle tone, morbid obesity, previous upper airway trauma, a respiratory distress index of greater than 40, or a low oxygen concentration. Apnea monitors and oximeters should be used before surgery for these high-risk children with OSAS. Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BIPAP) can be used to manage patients with upper airway obstruction occurring either before or after surgery.
Objective. The aim of this research was to describe the postoperative respiratory complications after tonsillectomy and/or adenoidectomy (T and/or A) in children with obstructive sleep apnea syndrome (OSAS), to define which children are at risk for these complications, and to determine whether continuous positive airway pressure (CPAP) is an effective strategy for dealing with these complications. Methods. The data for this study were gathered through a retrospective chart review of all children 15 years of age or younger with polysomnographically (PSG) proven OSAS who had a T and/or A at Hennepin County Medical Center between January 1985 and September 1992. Particular attention was paid to factors that contributed to the OSAS, postoperative respiratory complications, and intervention strategies for dealing with these complications. Results. The charts of 37 children with OSAS documented by preoperative PSG who later had a T and/or A were reviewed retrospectively. Ten of these children had significant postoperative respiratory compromise secondary to OSAS that prolonged their hospital stay from 1 to 30 days and caused symptoms ranging from [O.sub.2] desaturation 40 and (2) [SaO.sub.2] nadir