1
|
Cai BB, Wang DP. Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000657. [PMID: 38025904 PMCID: PMC10668248 DOI: 10.1136/wjps-2023-000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Postoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs in neonates undergoing non-cardiothoracic surgery. Methods In this retrospective study, all neonates who underwent non-cardiothoracic surgery in a children's hospital from October 2020 to September 2022 were included for analysis. Demographic data and perioperative variables were obtained. The primary outcome was the occurrence of PPCs. Univariate analysis and multivariable logistic regression analysis were used to investigate the effect of patient-related factors on the occurrence of PPCs. Results Totally, 867 neonatal surgery patients met the inclusion criteria in this study, among which 35.3% (306/867) patients experienced pulmonary complications within 1 week postoperatively. The PPCs observed in this study were 51 exacerbations of pre-existing pneumonia, 198 new patchy shadows, 123 new pulmonary atelectasis, 10 new pneumothorax, and 6 new pleural effusion. Patients were divided into two groups: PPCs (n=306) and non-PPCs (n=561). The multivariate stepwise logistic regression analysis revealed five independent risk factors for PPCs: corrected gestational age (OR=0.938; 95% CI 0.890 to 0.988), preoperative pneumonia (OR=2.139; 95% CI 1.033 to 4.426), length of surgery (> 60 min) (OR=1.699; 95% CI 1.134 to 2.548), preoperative mechanical ventilation (OR=1.857; 95% CI 1.169 to 2.951), and intraoperative albumin infusion (OR=1.456; 95% CI 1.041 to 2.036) in neonates undergoing non-cardiothoracic surgery. Conclusion Identifying risk factors for neonatal PPCs will allow for the identification of patients who are at higher risk and intervention for any modifiable risk factors identified.
Collapse
Affiliation(s)
- Bin Bin Cai
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hang Zhou, China
| | - Dong Pi Wang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hang Zhou, China
| |
Collapse
|
2
|
Keserű F, Sipos Z, Farkas N, Hegyi P, Juhász MF, Jászai VA, Párniczky A, Benedek PE. The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta-analysis. Pediatr Pulmonol 2022; 57:2889-2902. [PMID: 36030550 DOI: 10.1002/ppul.26121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) appears in 2%-5% of children, with first-line treatment being adenotonsillar (AT) surgery. Our aim was to examine the risk of postoperative respiratory complications (PoRCs) in non-OSA and the different OSA severity (mild, moderate, severe) groups. STUDY DESIGN We conducted a systematic review and meta-analysis of studies comparing PoRCs following AT surgery in children with and without OSA. METHODS Nineteen observational studies were identified with the same search key used in MEDLINE, Embase, and CENTRAL. The connection between PoRCs, the presence and severity of OSA, and additional comorbidities were examined. Odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS We found that PoRCs appeared more frequently in moderate (p = 0.048, OR: 1.79, CI [1.004, 3.194]) and severe OSA (p = 0.002, OR: 4.06, CI [1.68, 9.81]) compared to non-OSA patients. No significant difference was detected in the appearance of major complications (p = 0.200, OR: 2.14, CI [0.67, 6.86]) comparing OSA and non-OSA populations. No significant difference was observed in comorbidities (p = 0.669, OR: 1.29, CI [0.40, 4.14]) or in the distribution of PoRCs (p = 0.904, OR: 0.94, CI [0.36, 2.45]) between the two groups. CONCLUSION Uniform guidelines and a revision of postoperative monitoring are called for as children with moderate and severe OSA are more likely to develop PoRCs following AT surgery based on our results, but no significant difference was found in mild OSA. Furthermore, the presence of OSA alone is not associated with an increased risk of developing major complications.
Collapse
Affiliation(s)
- Fanni Keserű
- Heim Pál National Paediatric Institute, Budapest, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Sipos
- Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Márk Félix Juhász
- Heim Pál National Paediatric Institute, Budapest, Hungary.,Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Viktória Adrienn Jászai
- Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Andrea Párniczky
- Heim Pál National Paediatric Institute, Budapest, Hungary.,Medical School, Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Pálma Edina Benedek
- Heim Pál National Paediatric Institute, Budapest, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
3
|
Brock R, Chu A, Lu S, Brindle ME, Somayaji R. Postoperative complications after gastrointestinal pediatric surgical procedures: outcomes and socio-demographic risk factors. BMC Pediatr 2022; 22:358. [PMID: 35733099 PMCID: PMC9215078 DOI: 10.1186/s12887-022-03418-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several socio-demographic characteristics are associated with complications following certain pediatric surgical procedures. In this comprehensive study, we sought to determine socio-demographic risk factors and resource utilization of children with complications after common pediatric surgical procedures. METHODS We performed a population-based cohort study utilizing the 2016 Healthcare Cost and Use Project Kids' Inpatient Database (KID) to identify and characterize pediatric patients (age 0-21 years) in the United States with common inpatient pediatric gastrointestinal surgical procedures: appendectomy, cholecystectomy, colonic resection, pyloromyotomy and small bowel resection. Multivariable logistic regression modeling was used to identify socio-demographic predictors of postoperative complications. Length of stay and hospitalization costs for patients with and without postoperative complications were compared. RESULTS A total of 66,157 pediatric surgical hospitalizations were identified. Of these patients, 2,009 had postoperative complications. Male sex, young age, African American and Native American race and treatment in a rural hospital were associated with significantly greater odds of postoperative complications. Mean length of stay was 4.58 days greater and mean total costs were $11,151 (US dollars) higher in the complication cohort compared with patients without complications. CONCLUSIONS Postoperative complications following inpatient pediatric gastrointestinal surgery were linked to elevated healthcare-related expenditure. The identified socio-demographic risk factors should be considered in the risk stratification before pediatric surgical procedures. Targeted interventions are required to reduce preventable complications and surgical disparities.
Collapse
Affiliation(s)
- Robert Brock
- Department of Pediatric and Adolescent Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Angel Chu
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shengjie Lu
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Elizabeth Brindle
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
| |
Collapse
|
4
|
Shaikh N, Tumlin P, Morrow V, Bulbul MG, Coutras S. Does length of time between cases affect resident operative time for tonsillectomy and adenoidectomy? Int J Pediatr Otorhinolaryngol 2022; 154:111045. [PMID: 35038673 DOI: 10.1016/j.ijporl.2022.111045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effect of prolonged time intervals between tonsillectomy and adenoidectomy (TA) on resident operative time and complications. STUDY DESIGN Retrospective cohort. SETTING Tertiary academic hospital. METHODS This retrospective study covers a five-year period from 2015 to 2020. Time intervals between isolated pediatric TA cases performed by eight otolaryngology residents were reviewed to assess effect on operative time (defined as prolonged if ≥ 30 min and non-prolonged if < 30 min). Intervals including a procedure involving either a tonsillectomy or adenoidectomy that was a non-isolated TA were excluded. RESULTS A total of 309 isolated TAs were identified with 67.3% of procedures performed under 30 min. The mean surgical time interval between procedures was 5.83 ± 10.02 days (range 0.02-69.82). Most TAs were performed on patients aged 7 years or younger. Surgical time interval between TA was not a significant factor in determining prolonged operative time on univariable logistic regression, OR 1.01 (CI: 0.98 to 1.03) (p = 0.63). Patient age at surgery, adenoid grade, tonsil size and total number of TAs performed to date were significant factors in determining prolonged operative time in both univariable and multivariable logistic regression models. Prolonged operative time did not have a significant effect on readmission, reoperation, or post-operative bleeding. CONCLUSION Extended time interval (up to 3 months) between routine TA does not affect operative time. Expansion of our methodology to more complex cases would be beneficial in designing resident training curriculum.
Collapse
Affiliation(s)
- Noah Shaikh
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA.
| | - Parker Tumlin
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Vincent Morrow
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Mustafa G Bulbul
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Steven Coutras
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
5
|
Caetta A, Timashpolsky A, Tominaga SM, D'Souza N, Goldstein NA. Postoperative respiratory complications after adenotonsillectomy in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2021; 148:110835. [PMID: 34280801 DOI: 10.1016/j.ijporl.2021.110835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/20/2021] [Accepted: 07/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Children with obstructive sleep apnea are considered high risk for postoperative respiratory complications, but opinions differ regarding the polysomnography (PSG) criteria that suggest the need for postoperative admission. Our objective was to determine if otherwise healthy children age ≥3 years with an apnea-hypopnea index (AHI) < 24 on overnight PSG can be safely discharged on the same day of surgery. METHODS Case series with chart review of children age <18 years with positive PSG (AHI > 2) who underwent adenotonsillectomy (T&A) between January 2013 and August 2019. Data collected included patient demographics, medical history, comorbidities, PSG results, operative details, length of stay, intraoperative and postoperative respiratory complications and management. Potential predictors of respiratory complications were evaluated using chi-square/Fisher's exact test and 2-tailed unpaired t tests with the Bonferroni adjustment for multiple comparison artifact. The percentages of healthy children age ≥3 years who were discharged on the day of surgery at various PSG cutoffs were calculated. RESULTS Of the 560 children, mean (SD) age was 6.4 (3.7) years, 318 (56.8%) were male, 438 (78.2%) were African American, 243 (43.4%) were obese, 16 (2.9%) had Down Syndrome and 12 (2.1%) had sickle cell disease. Median (range) AHI was 12.3 (2-145). Fifteen children (2.7% [95% CI 1.3, 4.0]) had an intraoperative or postoperative respiratory complication. Minor complications including mild desaturation, stridor, croupy cough, and laryngospasm occurred in 9 patients and did not prolong the planned ambulatory or hospital stay. Of the 6 children with more severe complications including prolonged desaturation, tachypnea, atelectasis, intercostal retraction and obstructive apnea requiring continuous positive airway pressure, all were planned admissions based on age, severe sleep study indices (AHI ≥ 24 or oxygen saturation nadir < 80%) or underlying medical condition. Of the 165 children age ≥3 without medical comorbidities known to be predictive of postoperative complications with an AHI ≥10 but <24, 113 (68.5%) were discharged home on the same day of surgery without additional respiratory sequelae. CONCLUSIONS This study demonstrates a low risk of respiratory complications after T&A. Otherwise healthy children age ≥3 years with AHI <24 may be considered for ambulatory discharge.
Collapse
Affiliation(s)
- Alfonso Caetta
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA.
| | - Alisa Timashpolsky
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA.
| | - Stephanie M Tominaga
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA.
| | - Neeta D'Souza
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA. neeta.d'
| | - Nira A Goldstein
- Division of Pediatric Otolaryngology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 126, Brooklyn, NY, 11203, USA.
| |
Collapse
|
6
|
Corrêa CDC, Piña SP, Evangelisti M, Villa MP, Weber SAT. Quality of the Italian Websites for Parental Guidance on the Indications for Tonsillectomy in Children. Int Arch Otorhinolaryngol 2021; 25:e446-e452. [PMID: 34377183 PMCID: PMC8321631 DOI: 10.1055/s-0040-1716569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction The quality of information on websites about tonsillectomy regarding the knowledge level may be low. Tonsillectomy is a surgical procedure to hypertrophy of the palatine and pharyngeal tonsils. So, it is an invasive procedure with possible complications, which creates insecurity in parents. Significantly, Internet searches have been increased to address possible health concerns, questioning the quality of websites about tonsillectomy. Objective To evaluate the readability, reliability, and comprehensiveness of the Italian websites dedicated to parental guidance regarding the indications for tonsillectomy in children. Methods The search engine google.it was used to search the websites. The Gulpease index, which is a widely used readability formula ranging from 0 (difficult) to 100 (easy readability), was employed to evaluate these websites. The Health on the Net Code of Conduct (HONcode) was used to assess the quality of information, by taking ethical principles into account, with values ranging from 0 to 13. The content comprehensiveness of the web pages was assessed by assigning points ranging from 1 (very insufficient) to 5 (very satisfying) to each page. A final comparison with previous studies on tonsillectomy published on websites from other countries was performed. Results Fourteen Italian websites were selected, and the Gulpease index showed a mean average of 40.77 ± 8.45. The mean of the HONcode analysis was 6.00 ± 1.92, in which the principles with the poorest scores were Attribution and Update . As far as the comprehensiveness of the websites is concerned, the resulting mean was 2.57 ± 0.77, in which Indications was the topic with the highest mean, whereas Benefits was the one with the lowest. Conclusion The Italian websites were characterized by a lower readability level, a middle position regarding ethical principles, and the same (insufficient) comprehensiveness of tonsillectomy when compared with websites from different countries.
Collapse
Affiliation(s)
- Camila de Castro Corrêa
- Graduation Course of Speech-Language and Hearing Pathology, Universidade de Brasília, Brasília, DF, Brazil
- Graduation Course of Speech-Language and Hearing Pathology, Centro Universitário Planalto do Distrito Federal (UNIPLAN), Brasília, DF, Brazil
| | - Sofia Prata Piña
- Department of Ophthalmology, Otolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Melania Evangelisti
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Maria Pia Villa
- Pediatric Sleep Disease Center, Child Neurology, NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Silke Anna Theresa Weber
- Department of Ophthalmology, Otolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| |
Collapse
|
7
|
Allen DZ, Worobetz N, Lukens J, Sheehan C, Onwuka A, Dopirak RM, Chiang T, Elmaraghy C. Outcomes intensive care unit placement following pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2020; 129:109736. [PMID: 31704575 DOI: 10.1016/j.ijporl.2019.109736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Adenotonsillectomy (AT) is the most common surgical procedure for the treatment of sleep related breathing issues in children. While overnight observation in the hospital setting is utilized frequently in children after a AT, ICU setting is commonly used for patients with sleep apnea. This objective of this study is to examine factors associated with the preoperative decision to admit patients to PICU following AT as well as co-morbidities that may justify necessity for higher level of care. METHODS This is a retrospective chart review from the years of 2009-2016. All patients who underwent AT for known sleep-related breathing issues at Nationwide Children's Hospital were eligible for inclusion. A complication was defined as an adverse event such as pulmonary edema, re-intubation, or a bleeding event. Respiratory support was defined as utilizing supplementary oxygen for more than one day, positive pressure ventilation, or intubation. Proportions and medians were used to describe the overall rate of complications/complexities in care, and bivariate statistics were used to evaluate the relationship between patient characteristics and outcomes. Similar methods were used to evaluate factors associated with preoperative referral to the PICU. RESULTS There were 180 patients admitted to hospital in non-ICU setting and 158 patients with a planned PICU stay. The patients with planned PICU stays had higher rates of technological dependence (13% vs. 3%; p = 0.0006), perioperative sleep studies (80% vs. 29%; p < 0.0001), and more severe classifications of OSA (p < 0.0001). Patients with planned ICU placement also had higher rates of apneas, hypopneas, respiratory disturbance indexes, apnea hypopnea indexes, lower oxygen saturation nadirs, and a longer time spent below 90% oxygenation in sleep studies (p < 0.0001). Nearly 45% of the patients with planned ICU stays required respiratory support compared to just 8% of non-PICU patients. Additionally, 32% of the patients with planned ICU stays experienced complications compared to just 8% of the floor population. Complications were associated with younger ages, gastrointestinal comorbidities, technological dependence, viral infections, and a history of reflux. Interestingly, there were no differences in the complication rate by sleep studies findings. Similarly, there were no population level differences between patients who required respiratory support in the ICU and those that did not. Unplanned PICU placement was a rare but significant adverse event (n = 24). None of the hypothesized risk factors were associated with unplanned PICU placement. CONCLUSIONS This study suggest that while our pre-operative referral program for PICU placement is effective in identifying patients needing higher levels of care, the program places many patients in the PICU who did not utilize respiratory support or suffer from complications. We observed some misalignment between characteristics associated with planned ICU stays and actual complications. This suggests that patients with specific clinical histories, not findings on their sleep studies, should be prepared to receive higher levels of care.
Collapse
Affiliation(s)
- David Z Allen
- The Ohio State College of Medicine, Columbus, OH, USA
| | - Noah Worobetz
- The Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Cameron Sheehan
- The Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Amanda Onwuka
- The Center for Surgical Outcomes and Research, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Tendy Chiang
- The Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- The Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.
| |
Collapse
|
8
|
Katz SL, Monsour A, Barrowman N, Hoey L, Bromwich M, Momoli F, Chan T, Goldberg R, Patel A, Yin L, Murto K. Predictors of postoperative respiratory complications in children undergoing adenotonsillectomy. J Clin Sleep Med 2019; 16:41-48. [PMID: 31957650 DOI: 10.5664/jcsm.8118] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is commonly treated with adenotonsillectomy (AT), bringing risk of perioperative respiratory adverse events (PRAEs). We aimed to concurrently identify clinical and polysomnographic predictors of PRAEs in children undergoing AT. METHODS Retrospective study of children undergoing AT at a tertiary-care pediatric hospital, with prior in-hospital polysomnography, January 2010 to December 2016. PRAEs included those requiring oxygen, jaw thrust, positive airway pressure, or mechanical ventilation. Relationships of PRAEs to preoperative comorbidities or polysomnography results were examined with univariable logistic regression. Variables with P < .1 and age were included in backward stepwise multivariable logistic regression. Predictive performance (area under the curve, AUC) was validated with bootstrap resampling. RESULTS Analysis included 374 children, median age 6.1 years; 286 (76.5%) had ≥ 1 comorbidity. 344 (92.0%) had sleep-disordered breathing; 232 (62.0%) moderate-severe; 66 (17.6%) had ≥ 1 PRAE. PRAEs were more frequent in children with craniofacial, genetic, cardiac, airway anomaly, or neurological conditions, AHI ≥ 5 events/h and oxygen saturation nadir ≤ 80% on preoperative polysomnography. Prediction modeling identified cardiac comorbidity (odds ratio [OR] 2.09 [1.11, 3.89]), airway anomaly (OR 3.19 [1.33, 7.49]), and younger age (OR < 3 years: 4.10 (1.79, 9.26; 3 to 6 years: 2.21 [1.18, 4.15]) were associated with PRAEs (AUC 0.74; corrected AUC 0.68). CONCLUSIONS Prediction modeling concurrently evaluating comorbidities and polysomnography metrics identified cardiac disease, airway anomaly, and young age as independent predictors of PRAEs. These findings suggest that medical comorbidity and age are more important factors in predicting PRAEs than PSG metrics in a medically complex population.
Collapse
Affiliation(s)
- Sherri L Katz
- Children's Hospital of Eastern Ontario, Department of Pediatrics, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Lynda Hoey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Matthew Bromwich
- Children's Hospital of Eastern Ontario, Department of Pediatrics, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Theodora Chan
- McMaster University, School of Physiotherapy, Hamilton, Ontario, Canada
| | - Reuben Goldberg
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Abhilasha Patel
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Li Yin
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Kimmo Murto
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Department of Anesthesia, Ottawa, Ontario, Canada
| |
Collapse
|
9
|
Epidemiology and incidence of severe respiratory critical events in ear, nose and throat surgery in children in Europe: A prospective multicentre observational study. Eur J Anaesthesiol 2019; 36:185-193. [PMID: 30640246 DOI: 10.1097/eja.0000000000000951] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ear, nose and throat (ENT) surgery, the most frequently performed surgical procedure in children, is a strong predictor for peri-operative respiratory complications. However, there is no clear information about peri-operative respiratory severe critical events (SCEs) associated with anaesthesia management of ENT children in Europe. OBJECTIVE To characterise the epidemiology and incidence of respiratory SCEs during and following ENT surgery in Europe and to identify the risk factors for their occurrence. DESIGN A secondary analysis of the Anaesthesia PRactice In Children Observational Trial, a prospective observational multicentre cohort trial. SETTING The study included 261 centres across 33 European countries and took place over a consecutive 2-week recruitment period between April 2014 and January 2015. PATIENTS We extracted data from 5592 ENT surgical procedures that were performed on 5572 children aged 6.0 (3.6) years (mean (SD)) from the surgical database and compared these with data from 15 952 non-ENT surgical children aged 6.7 (4.8) years. MAIN OUTCOME MEASURES The primary outcome was the incidence of respiratory SCEs (laryngospasm, bronchospasm and new onset of postoperative stridor). Secondary outcomes were the differences in epidemiology between ENT children and non-ENT surgical children and the risk factors for the occurrence of respiratory SCEs. RESULTS The incidence (95% confidence interval) of any respiratory SCE (laryngospasm, bronchospasm and postoperative stridor) was 3.93% (3.46 to 4.48) and was significantly higher than that observed in non-ENT surgical children [2.61% (2.37 to 2.87)], with a relative risk of 1.51 (1.28 to 1.77), P less than 0.0001. Younger age (14% decrease in critical events by increasing year, P < 0.0001), history of snoring, recent upper respiratory tract infection and recent wheezing increased the risk of suffering a SCE by over two-fold (P < 0.0001). There was also some evidence for a positive association with age below 4.6 years and lower surgical volume thresholds (<20 cases/2 weeks). CONCLUSION The results of this study provide additional evidence for strong associations between risk factors and respiratory SCEs in children having ENT surgery. These observations may facilitate the implementation of good clinical practice recommendations for ENT patients in Europe. TRIAL REGISTRATION ClinicalTrials.gov, number NCT01878760.
Collapse
|
10
|
Ventilation, airway management, complications, perioperative anxiety: Children will definitely never be small adults. Anaesth Crit Care Pain Med 2018; 37:403-404. [PMID: 30236473 DOI: 10.1016/j.accpm.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
11
|
Saito J, Kimura F, Hashimoto H, Sakai T, Hirota K. Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report. JA Clin Rep 2018; 4:34. [PMID: 32026003 PMCID: PMC6966979 DOI: 10.1186/s40981-018-0171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background We report the case of a child with Krabbe disease who underwent three repeated surgeries and anesthetic management, and we discuss the major concerns about Krabbe disease and the usefulness of a perioperative administration of dexmedetomidine to prevent emergence agitation and hypertension. The patient was scheduled to undergo bilateral orchiopexy, adenotonsillectomy, and knee flexor tendon lengthening under general anesthesia during a 2-year period. Case presentation Adenotonsillectomy was scheduled as the second operation when the patient was 4 years old. His height and body weight were 93 cm and 10.3 kg, respectively. Anesthesia was induced with 8% sevoflurane mixed with 6 L/min of O2 and maintained with N2O (3.5 L/min), O2 (1.5 L/min), and sevoflurane (1.5–2.0%). Upon completion of the right tonsillectomy, 1 h before the end of the surgery, a continuous infusion of dexmedetomidine (0.2 μg/kg/h) was started to prevent emergence agitation, irritability, resultant hypertension, and postoperative bleeding. Fentanyl (25 μg) was administered intravenously to reduce postoperative pain. The surgery was uneventful, and the patient’s emergence from general anesthesia was prompt. He exhibited no symptoms of emergence agitation or irritability. During his stay in the intensive care unit, 0.2–0.7 μg/kg/h of dexmedetomidine and 6.25 μg/h of fentanyl were continuously administered. The patient was discharged to the ward the following morning without complications. Conclusions The perioperative administration of dexmedetomidine was useful to prevent emergence agitation, hypertension, and resultant postoperative bleeding in a pediatric patient with Krabbe disease. Three repeated anesthetic management using inhalation anesthesia were completed uneventfully without muscle relaxants.
Collapse
Affiliation(s)
- Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
| | - Futoshi Kimura
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Hiroshi Hashimoto
- Department of Anesthesiology, Odate Municipal General Hospital, Odate, Japan
| | - Tetsuhiro Sakai
- Department of Anesthesiology, Mutsu General Hospital, Mutsu, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| |
Collapse
|