Perioperative adverse respiratory events in children with obstructive sleep apnoea

Background: Obstructive sleep apnoea (OSA) in children is associated with the development of perioperative adverse respiratory events. The aim of our study was to find out the incidence of perioperative adverse respiratory events, to identify the risk predictors and to determine the appropriate anaesthetic agents in children with OSA. Methods: After obtaining approval from the the Institutional Review Board, 189 children with OSA who had undergone adenotonsillectomy between 2004 and 2009 were selected from a retrospective review of case files. Variables recorded included demographic data, coexistent medical illnesses, anaesthetic techniques (including induction agents and muscle relaxants) and perioperative analgesia. The severity of OSA was determined based on polysomnographic criteria. Adverse events including difficult airway, desaturation due to bronchospasm or laryngospasm, postoperative desaturation and unplanned intensive care unit (ICU) admission occurring up to 24 h postoperatively were recorded. Results: The incidence of perioperative respiratory adverse events was 19.6%. Severe OSA (odds ratio [OR] 5.8; 95% confidence interval [CI] 1.8–18.53; P = 0.003) and moderate OSA (OR 3.9; 95% CI 1.1–13.1; P = 0.029) were independent risk factors associated with complications. There was no correlation between the intraoperative anaesthetic techniques or use of perioperative opioid analgesics and the perioperative adverse respiratory events. Conclusions: Preoperative diagnosis of OSA using polysomnography has been shown to identify children who are at increased risk of perioperative adverse respiratory events in children. In our review, 19.6% of children with OSA were at risk. The use of a severity index may better identify children at higher risk.