Usha Shenoy, Bijoy Chirayath, P V Narayanan, Avni Francis, Mariam Koshy Thomas, Rakesh Rajagopal
{"title":"口咽裂畸形手术患儿围手术期呼吸不良事件的预测因素：一项前瞻性观察研究（PRAE-OPCD研究）。","authors":"Usha Shenoy, Bijoy Chirayath, P V Narayanan, Avni Francis, Mariam Koshy Thomas, Rakesh Rajagopal","doi":"10.1111/pan.15100","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Children with oropharyngeal cleft deformity (OPCD) undergoing reconstructive surgery are at greater risk for perioperative respiratory adverse events (PRAEs). Predictors for PRAE specific to this population have not been investigated, despite it being the most common congenital malformation seen worldwide.</p><p><strong>Materials and methods: </strong>This single-center, prospective, observational study recruited 270 children under 2 years of age, undergoing elective cleft surgery from May 1, 2023, to June 30, 2024. The primary aim was to identify predictors of pre-determined PRAE (laryngospasm, bronchospasm, stridor, airway obstruction and desaturation). We also aimed to identify the more common PRAE in this patient population.</p><p><strong>Results: </strong>Of the 345 children who underwent cleft correction surgery, 270 were included in the study. There was a statistically increased incidence of PRAE in children with a positive history of upper airway obstruction and a history of feeding disorder in early infancy, Cormack Lehane (CL) grade ≥ 3, and COLDS score ≥ 15. A significant association was found between the COLDS score (odds ratio [OR]: 0.005, 95% confidence interval [CI]: 0.001-0.049), CL grade ≥ 3 (OR: 0.008, 95% CI: 0.001-0.078) and PRAE.COLDS score ≥ 15 (p = 0.046; adjusted OR [AOR]: 18.07, 95% CI: 1.06-308.45) and CL grade ≥ 3 (p = 0.007; AOR: 41.79, 95% CI: 2.74-636.40) were associated with PRAEs in the multivariate regression. The overall incidence of PRAE was 1.85%, laryngospasm being the most common.</p><p><strong>Conclusion: </strong>Children with OPCD with higher COLDS scores and/or those with a CL grade view ≥ 3 are more likely to develop PRAE following corrective surgery. The limited data indicate the increased possibility of PRAE in children with a positive history of airway obstruction and/or feeding disorder in early infancy. The relatively low incidence of PRAE restricts the generalizability.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictors of Perioperative Respiratory Adverse Events in Children Undergoing Surgery for Oropharyngeal Cleft Deformity: A Prospective Observational Study (PRAE-OPCD Study).\",\"authors\":\"Usha Shenoy, Bijoy Chirayath, P V Narayanan, Avni Francis, Mariam Koshy Thomas, Rakesh Rajagopal\",\"doi\":\"10.1111/pan.15100\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Children with oropharyngeal cleft deformity (OPCD) undergoing reconstructive surgery are at greater risk for perioperative respiratory adverse events (PRAEs). Predictors for PRAE specific to this population have not been investigated, despite it being the most common congenital malformation seen worldwide.</p><p><strong>Materials and methods: </strong>This single-center, prospective, observational study recruited 270 children under 2 years of age, undergoing elective cleft surgery from May 1, 2023, to June 30, 2024. The primary aim was to identify predictors of pre-determined PRAE (laryngospasm, bronchospasm, stridor, airway obstruction and desaturation). We also aimed to identify the more common PRAE in this patient population.</p><p><strong>Results: </strong>Of the 345 children who underwent cleft correction surgery, 270 were included in the study. There was a statistically increased incidence of PRAE in children with a positive history of upper airway obstruction and a history of feeding disorder in early infancy, Cormack Lehane (CL) grade ≥ 3, and COLDS score ≥ 15. A significant association was found between the COLDS score (odds ratio [OR]: 0.005, 95% confidence interval [CI]: 0.001-0.049), CL grade ≥ 3 (OR: 0.008, 95% CI: 0.001-0.078) and PRAE.COLDS score ≥ 15 (p = 0.046; adjusted OR [AOR]: 18.07, 95% CI: 1.06-308.45) and CL grade ≥ 3 (p = 0.007; AOR: 41.79, 95% CI: 2.74-636.40) were associated with PRAEs in the multivariate regression. The overall incidence of PRAE was 1.85%, laryngospasm being the most common.</p><p><strong>Conclusion: </strong>Children with OPCD with higher COLDS scores and/or those with a CL grade view ≥ 3 are more likely to develop PRAE following corrective surgery. The limited data indicate the increased possibility of PRAE in children with a positive history of airway obstruction and/or feeding disorder in early infancy. The relatively low incidence of PRAE restricts the generalizability.</p>\",\"PeriodicalId\":19745,\"journal\":{\"name\":\"Pediatric Anesthesia\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-03-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/pan.15100\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/pan.15100","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Predictors of Perioperative Respiratory Adverse Events in Children Undergoing Surgery for Oropharyngeal Cleft Deformity: A Prospective Observational Study (PRAE-OPCD Study).
Background and objectives: Children with oropharyngeal cleft deformity (OPCD) undergoing reconstructive surgery are at greater risk for perioperative respiratory adverse events (PRAEs). Predictors for PRAE specific to this population have not been investigated, despite it being the most common congenital malformation seen worldwide.
Materials and methods: This single-center, prospective, observational study recruited 270 children under 2 years of age, undergoing elective cleft surgery from May 1, 2023, to June 30, 2024. The primary aim was to identify predictors of pre-determined PRAE (laryngospasm, bronchospasm, stridor, airway obstruction and desaturation). We also aimed to identify the more common PRAE in this patient population.
Results: Of the 345 children who underwent cleft correction surgery, 270 were included in the study. There was a statistically increased incidence of PRAE in children with a positive history of upper airway obstruction and a history of feeding disorder in early infancy, Cormack Lehane (CL) grade ≥ 3, and COLDS score ≥ 15. A significant association was found between the COLDS score (odds ratio [OR]: 0.005, 95% confidence interval [CI]: 0.001-0.049), CL grade ≥ 3 (OR: 0.008, 95% CI: 0.001-0.078) and PRAE.COLDS score ≥ 15 (p = 0.046; adjusted OR [AOR]: 18.07, 95% CI: 1.06-308.45) and CL grade ≥ 3 (p = 0.007; AOR: 41.79, 95% CI: 2.74-636.40) were associated with PRAEs in the multivariate regression. The overall incidence of PRAE was 1.85%, laryngospasm being the most common.
Conclusion: Children with OPCD with higher COLDS scores and/or those with a CL grade view ≥ 3 are more likely to develop PRAE following corrective surgery. The limited data indicate the increased possibility of PRAE in children with a positive history of airway obstruction and/or feeding disorder in early infancy. The relatively low incidence of PRAE restricts the generalizability.
期刊介绍：
Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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