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Paediatr Anaesth. 2015 Apr;25(4):392-9. doi: 10.1111/pan.12561. Epub 2014 Nov 5.

Perioperative respiratory complications following awake and deep extubation in children undergoing adenotonsillectomy.

Author information

1
Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.

Abstract

BACKGROUND:

Perioperative respiratory complications after adenotonsillectomy (T&A) are common and have been described to occur more frequently in children below 3 years of age, those with cranio-facial abnormalities, Down syndrome, obstructive sleep apnea, morbid obesity, and failure to thrive.

AIMS:

To investigate the association between awake vs deep tracheal extubation and perioperative respiratory conditions.

RESULTS:

The primary outcome was any perioperative respiratory complication. Major complications included the need for airway reinstrumentation, continuous or bi-level positive airway pressure (CPAP or BiPAP) and ventilation, or pharmacologic intervention for managing airway obstruction. Minor respiratory complications included persistent hypoxemia defined as oxygen saturation (SpO2 ) <92% for ≥30 s or postoperative oxygen dependence for hypoxemia for ≥15 min. There was no statistically significant difference in the incidence of any perioperative respiratory complication in children undergoing an awake vs deep extubation (18.5% and 18.9% for awake and deep extubation, respectively (P = 0.93)). Only low weight (≤14 kg) was associated with increased perioperative respiratory complications (P = 0.005). In this study, factors found not to be statistically significant with perioperative respiratory complications included age; presence of Down syndrome, cranio-facial abnormality, or cerebral palsy; obstructive sleep apnea confirmed by polysomnography; diagnosis of obstructive sleep apnea by clinical history; presence of an upper respiratory tract infection (URI) within 2 weeks of presentation; history of reactive airway disease; status at extubation; endtidal sevoflurane and carbon dioxide concentrations at extubation; total intraoperative opioids administered in morphine equivalents (mg·kg(-1) ); administration of propofol at extubation; and intraoperative administration of an anticholinergic drug.

CONCLUSIONS:

There was no difference in the incidence of perioperative respiratory complications in children undergoing a T&A following an awake vs deep extubation. Only weight ≤14 kg was associated with increased perioperative respiratory complications.

KEYWORDS:

airway extubation; anesthesia; complications; obstructive sleep apnea; otolaryngology; pediatrics; tonsillectomy

PMID:
25370474
DOI:
10.1111/pan.12561
[Indexed for MEDLINE]

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