BMJ  2005;331:405-406 (13 August), doi:10.1136/bmj.331.7513.405-c

Letter

Childhood obstructive sleep apnoea

Anaesthetic implications for adenotonsillectomy are important

EDITOR—Kotagal correctly mentions that adenotonsillectomy is performed as a potential treatment for children with obstructive sleep apnoea and highlights some of the perioperative risks.¹ We write to emphasise this, since these children may present important challenges to safe and effective anaesthetic management.

Under anaesthaesia, children with obstructive sleep apnoea have impaired ventilatory responses to carbon dioxide compared with controls.² This may account, in part, for the increase in respiratory complications recorded in these patients. Children aged 3 years or younger, and those with cardiac or neurological problems are at extra risk of such postoperative complications.³

On a practical note, administration of atropine at anaesthetic induction has been reported to reduce respiratory complications.⁴ For children with "severe" obstructive sleep apnoea, having their operation in the morning is associated with less postoperative hypoxaemia than that seen in those operated on in the afternoon.⁵

dball{at}nhs.net
Department of Anaesthesia, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP

Department of Anaesthesia, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP

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Competing interests: None declared.

References

1. Kotagal S. Childhood obstructive sleep apnoea. BMJ 2005;330: 978-9. (30 April.)[Free Full Text]
2. Strauss SG, Lynn AM, Bratton SL, Nespaca MK. Ventilatory response to CO₂ in children with obstructive sleep apnea from adenotonsillar hypertrophy. Anesth Analg 1999;89: 328-32.[Abstract/Free Full Text]
3. Biavati MJ, Manning SC, Phillips DL. Predictive factors for respiratory complications after tonsillectomy and adenoidectomy in children. Arch Otolaryngol Head Neck Surg 1997;123: 517-21.[Abstract]
4. Brown KA, Morin I, Hickey C, Manoukian JJ, Nixon JM, Brouillette RT. Urgent adenotonsillectomy: an analysis of risk factors associated with postoperative respiratory morbidity. Anesthesiology 2003;99: 586-95.[CrossRef][ISI][Medline]
5. Koomson A, Morsin I, Brouilette R, Brown KA. Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon. Can J Anaesth 2004;51: 62-7.[Abstract/Free Full Text]

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Childhood obstructive sleep apnoea

Suresh Kotagal
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