Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea.
OBJECTIVE
a) To determine the need for intensive monitoring on the first operative night of surgery in children undergoing adenotonsillectomy for mild obstructive sleep apnea; b) to examine the effect of narcotics on postoperative obstructive sleep apnea.


METHODS
Randomized, prospective study.


METHODS
University hospital.


METHODS
Children, ranging in age between 1 and 18 yrs, presented to the Pediatric Otolaryngology Clinic for adenotonsillectomy for mild obstructive sleep apnea defined as from one to 15 obstructive apnea events per hour on preoperative polysomnogram.


METHODS
Patients were assigned to receive either a narcotic- or a halothane-based anesthetic for adenotonsillectomy. A postoperative polysomnogram was performed in the pediatric intensive care unit on the first operative night.


RESULTS
Eighteen patients were recruited, 15 of whom met inclusion criteria: nine patients received a halothane-based anesthetic and six patients received a fentanyl-based anesthetic. When the data were analyzed by pooling both groups, the differences between pre- and postoperative sleep studies demonstrated a reduction in the number of obstructive events and less severe oxygen desaturations on the operative night. Total sleep time between the two sleep studies decreased from 371 +/- 13 to 304 +/- 14 mins. The number of obstructive apnea events/hr decreased as well. The lowest oxygen saturation measured during rapid eye movement sleep was 78 +/- 5% preoperatively and 92 +/- 1% postoperatively.


CONCLUSIONS
Our data suggest that children without underlying medical conditions, neuromotor diseases, or carniofacial abnormalities, 1 to 18 yrs of age, who suffer from mild obstructive sleep apnea, have improvements documented by polysomnography on the night of surgery following adenotonsillectomy and do not necessarily need to be monitored intensively. These findings were not significantly affected by the choice of intraoperative anesthetic.
Helfaer
M A
MA
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
McColley
S A
SA
Pyzik
P L
PL
Tunkel
D E
DE
Nichols
D G
DG
Baroody
F M
FM
April
M M
MM
Maxwell
L G
LG
Loughlin
G M
GM
D000233:Adenoidectomy; D000293:Adolescent; D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D017286:Polysomnography; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000601:surgery*; D014068:Tonsillectomy