Abstract
Objectives:
1) Elucidate the factors affecting emergence from anesthesia after adenotonsillectomy for obstructive sleep apnea (OSA) in children. 2) Highlight the advantages of a standardized anesthetic protocol in controlling peri-operative events.
Methods:
A non-randomized, prospective, observational study (n = 64) was designed to examine the relationship between the severity of OSA, as determined by apnea-hypopnea index (AHI) and oxygen saturation (SpO2) nadir, and indices of recovery, including time to 1) emergence after surgery, 2) extubation following emergence, and 3) discharge from the post-anesthesia care unit. A standardized anesthetic protocol was used in all patients using doses of opioids that inversely correlated with OSA severity.
Results:
A paradoxical yet significant reduction in recovery time was observed among patients with severe OSA following surgery; this reflected in quicker emergence, accelerated extubation, and shortened postanesthesia care unit discharge times (analysis of variance, Tukey-Kramer post-hoc tests, P < 0.001) besides a reduction in adverse events. In addition, the relationship between polysomnography (PSG)-derived AHI and SpO2 nadir varied inversely with each of the recovery indices, as determined by a linear regression analysis (t-tests, P <0.001).
Conclusions:
Emergence from anesthesia after adenotonsillectomy can be controlled by a standardized anesthesia protocol using different combinations of sedation and analgesia. The severity of sleep apnea and hypoxemia do not independently appear to play a significant role in recovery from anesthesia. By using a standardized anesthetic protocol with diminishing doses of opioids with increasing severity of OSA, our results indicate a striking departure from previously observed findings relating to post-procedural respiratory complications following adenotonsillectomy.
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