Department of Anesthesia, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC H3H 1P3, Canada.
Anesth Analg. 2010 Apr 1;110(4):1093-101. doi: 10.1213/ANE.0b013e3181cfc435. Epub 2010 Feb 8.
A high incidence of respiratory morbidity after adenotonsillectomy is reported in children with obstructive sleep apnea syndrome (OSAS). In an effort to decrease this morbidity, we implemented perioperative guidelines recommending an adjustment in the administration of opioids, dexamethasone, and atropine in children with OSAS who demonstrated recurrent episodes of profound hypoxemia during the perioperative sleep study.
We performed a retrospective review and compared results with historic data from 2001. The primary outcome variable was a major respiratory medical intervention (MMI(Respiratory)). The severity of OSAS was classified with the McGill Oximetry Scoring (MOS) system, and our focus was on those children demonstrating repetitive desaturation <80% (MOS4).
The medical records of 292 children who underwent adenotonsillectomy between October 2002 and February 2006 met the inclusion criteria and 97 had been assigned MOS4. Eleven children (11.3%) required an MMI(Respiratory). In 2001, 8 children (29.6%), assigned MOS4, required an MMI(Respiratory). Comparing the new and old guidelines, the adjusted odds ratio for MMI(Respiratory) in MOS4 was 0.30 (95% CI: 0.10-0.85). The key elements achieving this reduction in MMI(Respiratory) were dexamethasone administration and a reduced opioid dosage. In 2002 to 2006, the intraoperative opioid dose, expressed in morphine equivalents, administered to the MOS4 group was 0.10 mg . kg(-1) (0.06-0.12 mg . kg(-1)), and the postoperative morphine dose was 0.02 mg . kg(-1) (0-0.07 mg . kg(-1)). Both doses were lower than the ones administered to the concurrent comparison group, P values <0.001.
A change in practice that included a dexamethasone administration and a reduction in opioid administration to children with profound recurrent hypoxia reduced the incidence of MMI(Respiratory) by >50%.
据报道，患有阻塞性睡眠呼吸暂停综合征（OSAS）的儿童在接受腺样体扁桃体切除术（adenotonsillectomy）后，呼吸道发病率较高。为了降低这种发病率，我们实施了围手术期指南，建议对在围手术期睡眠研究中反复出现严重低氧血症的 OSAS 儿童调整阿片类药物、地塞米松和阿托品的使用。
我们进行了回顾性研究，并将结果与 2001 年的历史数据进行了比较。主要观察结果变量是主要呼吸医疗干预（MMI(Respiratory)）。OSAS 的严重程度采用 McGill 血氧计评分（MOS）系统进行分类，我们的重点是那些反复出现 <80%（MOS4）的儿童。
2002 年 10 月至 2006 年 2 月期间，292 名接受腺样体扁桃体切除术的儿童的病历符合纳入标准，其中 97 名被分配 MOS4。11 名儿童（11.3%）需要进行 MMI(Respiratory)。2001 年，8 名（29.6%）被分配 MOS4 的儿童需要进行 MMI(Respiratory)。比较新旧指南，MOS4 中 MMI(Respiratory)的调整后比值比为 0.30（95%CI：0.10-0.85）。实现 MMI(Respiratory)减少的关键因素是地塞米松的使用和阿片类药物剂量的减少。2002 年至 2006 年，MOS4 组术中阿片类药物剂量（以吗啡当量表示）为 0.10mg/kg（0.06-0.12mg/kg），术后吗啡剂量为 0.02mg/kg（0-0.07mg/kg）。与同期比较组相比，这两个剂量均较低，P 值均<0.001。
对患有严重反复缺氧的儿童，改变实践，包括给予地塞米松和减少阿片类药物的使用，可使 MMI(Respiratory)的发生率降低>50%。
