To describe a minimalist approach to sedating children for DISE procedures.
Methods:
We searched existing literature and derived and tested our algorithm on patients using evidence-based studies.
Results:
We were able to successfully sedate, without airway intervention, 15 highly complex children with a variety of comorbidities for DISE procedures.
Conclusion:
We describe a minimalistic sedation approach for DISE procedures in highly complex children. Further studies are required to compare this regimen to natural sleep states.
FriedmanMWilsonMLinHCChangHW.Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009;140(6):800-808.
2.
BoudewynsAVerhulstSMarisMSaldienVVan de HeyningP.Drug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome. Sleep Med. 2014;15(12):1526-1531.
3.
FriedmanNRParikhSRIshmanSL, et al. The current state of pediatric drug-induced sleep endoscopy. Laryngoscope. 2017;127(1):266-272.
4.
TraxdorfMTschaikowskyKScherlCBauerJIroHAngererF.Drug-induced sleep endoscopy (DISE) with target controlled infusion (TCI) and bispectral analysis in obstructive sleep apnea. J Vis Exp. 2016.
5.
Carrasco LlatasMAgostini PorrasGCuesta GonzalezMT, et al. Drug-induced sleep endoscopy: a two drug comparison and simultaneous polysomnography. Eur Arch Otorhinolaryngol. 2014;271(1):181-187.
6.
RojewskiTESchullerDEClarkRWSchmidtHSPottsRE.Videoendoscopic determination of the mechanism of obstruction in obstructive sleep apnea. Otolaryngol Head Neck Surg. 1984;92(2):127-131.
7.
AyuseTInazawaTKurataS, et al. Mouth-opening increases upper-airway collapsibility without changing resistance during midazolam sedation. J Dent Res. 2004;83(9):718-722.
8.
CrawfordMWArricaMMacgowanCKYooSJ.Extent and localization of changes in upper airway caliber with varying concentrations of sevoflurane in children. Anesthesiology. 2006;105(6):1147-1152; discussion 5A.
9.
EastwoodPRSzollosiIPlattPRHillmanDR.Collapsibility of the upper airway during anesthesia with isoflurane. Anesthesiology. 2002;97(4):786-793.
10.
EastwoodPRPlattPRShepherdKMaddisonKHillmanDR.Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology. 2005;103(3):470-477.
11.
ChoJSSohSKimEJ, et al. Comparison of three sedation regimens for drug-induced sleep endoscopy. Sleep Breath. 2015;19(2):711-717.
12.
DrummondGB.Comparison of sedation with midazolam and ketamine: effects on airway muscle activity. Br J Anaesth. 1996;76(5):663-667.
13.
AmosJMDurrMLNardoneHCBaldassariCMDugginsAIshmanSL.Systematic review of drug-induced sleep endoscopy scoring systems. Otolaryngol Head Neck Surg. 2018;158(2):240-248.
14.
HongSDDhongHJKimHY, et al. Change of obstruction level during drug-induced sleep endoscopy according to sedation depth in obstructive sleep apnea. Laryngoscope. 2013;123(11):2896-2899.
15.
EvansRGCrawfordMWNoseworthyMDYooSJ.Effect of increasing depth of propofol anesthesia on upper airway configuration in children. Anesthesiology. 2003;99(3):596-602.
16.
ShepardJWJrStansonAWSheedyPFWestbrookPR.Fast-CT evaluation of the upper airway during wakefulness in patients with obstructive sleep apnea. Prog Clin Biol Res. 1990;345:273-279; discussion 80-82.
17.
KandilASubramanyamRHossainMM, et al. Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug-induced sleep endoscopy in children. Paediatr Anaesth. 2016;26(7):742-751.
18.
HohenhorstWRaveslootMJLKezirianEJVriesN de. Drug-induced sleep endoscopy in adults with sleep-disordered breathing: technique and the VOTE classification system. Oper Tech Otolayngol Head Neck Surg. 2012;23(1):11-18.
19.
GazzazMJIsaacAAndersonSAlsufyaniNAlrajhiYEl-HakimH.Does drug-induced sleep endoscopy change the surgical decision in surgically naive non-syndromic children with snoring/sleep disordered breathing from the standard adenotonsillectomy? A retrospective cohort study. J Otolaryngol Head Neck Surg. 2017;46(1):12.
20.
CoutrasSWLimjucoADavisKECarrMM.Sleep endoscopy findings in children with persistent obstructive sleep apnea after adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2018;107:190-193.
