Francis Aren, Eltaki Kareem, Bash Tal, Cortes Steven, Mojdehi Khosrow, Goldstein Nira A
State University of New York Downstate, Department of Otolaryngology, 134 Atlantic Ave., Brooklyn, NY 11201, United States.
Int J Pediatr Otorhinolaryngol. 2006 Sep;70(9):1517-21. doi: 10.1016/j.ijporl.2006.02.001. Epub 2006 Jul 7.
To prospectively monitor children who received preoperative sedation with midazolam hydrochloride prior to adenotonsillectomy (T&A) for treatment of sleep-disordered breathing with continuous pulse-oximetry to detect potential respiratory compromise.
Prospective, observational study.
Hospital-based pediatric otolaryngology practice.
Seventy children, aged 1-12 years, diagnosed with sleep-disordered breathing by clinical evaluation or polysomnography (PSG), with a median RDI of 14.25, undergoing T&A.
Children underwent a standardized anesthesia protocol including preoperative oral midazolam hydrochloride 0.5mg/kg, standard American Society of Anesthesiologists (ASA) monitoring, mask induction with sevoflurane, muscle relaxant with reversal if indicated, and intravenous dexamethasone sodium phosphate 0.5mg/kg. Children were monitored in the hospital until discharge criteria were met. Selected children with severe OSA were monitored overnight on the pediatric floor or the pediatric intensive care unit. Adverse respiratory events were defined as upper airway obstruction, hypoventilation, desaturation, bradycardia, or sustained lethargy.
Incidence of pre and postoperative obstructive complications.
During the study period only two patients (2.9%) had a measurable adverse event directly related to the administration of the sedation.
Based on sporadic reports of adverse airway events in children with obstructive sleep apnea receiving sedation, these children frequently do not receive preoperative sedation. Given the low morbidity of preoperative sedation in our population, many children with sleep-disordered breathing may safely be pre-medicated.
对因睡眠呼吸障碍接受腺样体扁桃体切除术（T&A）的儿童，在术前使用盐酸咪达唑仑进行镇静时，通过持续脉搏血氧饱和度监测进行前瞻性监测，以检测潜在的呼吸功能受损情况。
前瞻性观察性研究。
以医院为基础的儿科耳鼻喉科诊所。
70名年龄在1至12岁之间的儿童，经临床评估或多导睡眠图（PSG）诊断为睡眠呼吸障碍，平均呼吸紊乱指数（RDI）为14.25，并接受T&A手术。
儿童接受标准化麻醉方案，包括术前口服0.5mg/kg盐酸咪达唑仑、标准的美国麻醉医师协会（ASA）监测、七氟醚面罩诱导、必要时使用肌肉松弛剂及逆转剂，以及静脉注射0.5mg/kg磷酸地塞米松钠。儿童在医院接受监测，直至达到出院标准。部分患有严重阻塞性睡眠呼吸暂停（OSA）的儿童在儿科病房或儿科重症监护病房接受过夜监测。不良呼吸事件定义为上呼吸道阻塞、通气不足、血氧饱和度下降、心动过缓或持续嗜睡。
术前和术后阻塞性并发症的发生率。
在研究期间，仅有两名患者（2.9%）出现了与镇静药物使用直接相关的可测量不良事件。
基于关于阻塞性睡眠呼吸暂停儿童接受镇静时发生不良气道事件的零星报告，这些儿童通常不接受术前镇静。鉴于我们研究人群中术前镇静的低发病率，许多睡眠呼吸障碍儿童可以安全地进行术前用药。
