title: An audit of the use of an opiate sparing, multimodal analgesic regime in children with Sleep Disordered Breathing/Obstructive Sleep Apnoea undergoing adenotonsillectomy.
abstract: OBJECTIVE
  Children with Sleep Disordered Breathing/Obstructive Sleep Apnoea have an increased incidence of respiratory complications following adenotonsillectomy. This may be partly related to an increase in sensitivity to opiates. An audit of such cases undergoing adenotonsillectomy was performed with the following aims:
  
  
  METHODS
  All patients had Sleep Disordered Breathing/Obstructive Sleep Apnoea confirmed preoperatively by Overnight Oximetry Studies. Oximetry data was expressed as the lowest recorded saturation (SpO2 Low %) and number of significant desaturations (see text) per hour (ODI4%). Case notes and oximetry studies were scrutinized for relevant perioperative anaesthetic and analgesic data, risk factors and complications.
  
  
  RESULTS
  The overall incidence of major and minor respiratory complications was low (1.6% and 27% respectively). Children who suffered any complication were more likely to be younger (p=0.0078), have a lower SpO2 Low (p=0.004) and higher ODI4% (p=<0.0001). Multiple logistic regression showed ODI4% to be the best predictor of a potential respiratory complication (p=0.0032). An ODI4% of >8 may be the best cut off point in predicting complications (AUC=0.78, sensitivity=0.90) but it showed a poor specificity (0.57). Primary/secondary haemorrhage occurred in 0.4%/1.2% respectively and postoperative nausea and vomiting in 4.4%.
  
  
  CONCLUSIONS
  A low dose opiate-based, multi modal analgesic regime appears to be effective and safe in children with Sleep Disordered Breathing/Obstructive Sleep Apnoea undergoing adenotonsillectomy.
authors.affiliation: Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK. Electronic address: henrikh@adhb.govt.nz.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hack
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D010092:Oximetry; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000188:drug therapy / Q000601:surgery*; D020181:Sleep Apnea, Obstructive / Q000188:drug therapy / Q000601:surgery*; D014068:Tonsillectomy
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: Adenotonsillectomy; Analgesia; Obstructive Sleep Apnoea; Opiates; Respiratory complications