Preoperative sedation in pediatric patients with sleep-disordered breathing.
OBJECTIVE
Based on a few reports that describe obstructive sleep apnea (OSA) patients as having an increased risk of acute upper airway obstruction (UAO) after pharmacological sedation, this population is less likely to receive sedation prior to surgery. Our objective was to evaluate pediatric patients with sleep-disordered breathing who received preoperative sedation to determine if there was an increase in preoperative airway obstruction.


METHODS
Retrospective chart review from 1995 to 2000.


METHODS
Two tertiary care academic medical centers.


METHODS
Sixty-five children (mean age=4.7+/-2.3 years; 49 boys, 16 girls) diagnosed with sleep-disordered breathing by sleep study or clinical evaluation that received preoperative midazolam hydrochloride.


METHODS
The occurrence of preoperative adverse events defined as UAO, hypoventilation, desaturation, bradycardia, or sustained lethargy that required active intervention after the administration of midazolam hydrochloride within 24 h of surgery.


RESULTS
None of the 65 children evaluated in this study experienced respiratory compromise requiring intervention after the administration of preoperative sedation. Potential risk factors such as patients' age, sex, weight, comorbidities, midazolam hydrochloride dose, and severity of sleep apnea did not appear to affect outcome.


CONCLUSIONS
The preliminary data suggested that preoperative sedation might be safely administered to children with mild or moderate sleep-disordered breathing, and possibly to children with severe OSA, if children are closely observed prior to surgery. Further prospective studies are needed to confirm these results.
Cultrara
Anthony
A
Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203-2098, USA. cultrata@yahoo.com
Bennett
Garrett H
GH
Lazar
Craig
C
Bernstein
Joseph
J
Goldstein
Nira
N
D000046:Academic Medical Centers; D000233:Adenoidectomy / Q000379:methods*; D000293:Adolescent; D000403:Airway Resistance / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D008991:Monitoring, Physiologic; D017286:Polysomnography; D011300:Preoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D014068:Tonsillectomy / Q000379:methods*
D008874:Midazolam