Baijal Rahul G, Bidani Sudha A, Minard Charles G, Watcha Mehernoor F
Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.
Paediatr Anaesth. 2015 Apr;25(4):392-9. doi: 10.1111/pan.12561. Epub 2014 Nov 5.
Perioperative respiratory complications after adenotonsillectomy (T&A) are common and have been described to occur more frequently in children below 3 years of age, those with cranio-facial abnormalities, Down syndrome, obstructive sleep apnea, morbid obesity, and failure to thrive.
To investigate the association between awake vs deep tracheal extubation and perioperative respiratory conditions.
The primary outcome was any perioperative respiratory complication. Major complications included the need for airway reinstrumentation, continuous or bi-level positive airway pressure (CPAP or BiPAP) and ventilation, or pharmacologic intervention for managing airway obstruction. Minor respiratory complications included persistent hypoxemia defined as oxygen saturation (SpO2 ) <92% for ≥30 s or postoperative oxygen dependence for hypoxemia for ≥15 min. There was no statistically significant difference in the incidence of any perioperative respiratory complication in children undergoing an awake vs deep extubation (18.5% and 18.9% for awake and deep extubation, respectively (P = 0.93)). Only low weight (≤14 kg) was associated with increased perioperative respiratory complications (P = 0.005). In this study, factors found not to be statistically significant with perioperative respiratory complications included age; presence of Down syndrome, cranio-facial abnormality, or cerebral palsy; obstructive sleep apnea confirmed by polysomnography; diagnosis of obstructive sleep apnea by clinical history; presence of an upper respiratory tract infection (URI) within 2 weeks of presentation; history of reactive airway disease; status at extubation; endtidal sevoflurane and carbon dioxide concentrations at extubation; total intraoperative opioids administered in morphine equivalents (mg·kg(-1) ); administration of propofol at extubation; and intraoperative administration of an anticholinergic drug.
There was no difference in the incidence of perioperative respiratory complications in children undergoing a T&A following an awake vs deep extubation. Only weight ≤14 kg was associated with increased perioperative respiratory complications.
腺样体扁桃体切除术（T&A）围手术期呼吸并发症很常见，且据描述在3岁以下儿童、患有颅面畸形、唐氏综合征、阻塞性睡眠呼吸暂停、病态肥胖及生长发育不良的儿童中更频繁发生。
研究清醒状态下与深度气管拔管和围手术期呼吸状况之间的关联。
主要结局是任何围手术期呼吸并发症。主要并发症包括需要气道重新插管、持续或双水平气道正压通气（CPAP或BiPAP）及通气，或进行药物干预以处理气道阻塞。轻微呼吸并发症包括定义为氧饱和度（SpO2）<92%持续≥30秒或术后因低氧血症需氧持续≥15分钟的持续性低氧血症。在接受清醒拔管与深度拔管的儿童中，任何围手术期呼吸并发症的发生率无统计学显著差异（清醒拔管和深度拔管分别为18.5%和18.9%，P = 0.93）。仅低体重（≤14 kg）与围手术期呼吸并发症增加相关（P = 0.005）。在本研究中，发现与围手术期呼吸并发症无统计学显著关联的因素包括年龄；唐氏综合征、颅面畸形或脑瘫的存在；多导睡眠图确诊的阻塞性睡眠呼吸暂停；根据临床病史诊断的阻塞性睡眠呼吸暂停；就诊前2周内存在上呼吸道感染（URI）；反应性气道疾病史；拔管时状态；拔管时呼气末七氟烷和二氧化碳浓度；术中以吗啡当量（mg·kg⁻¹）计的总阿片类药物用量；拔管时丙泊酚的使用；以及术中抗胆碱能药物的使用。
在接受T&A的儿童中，清醒拔管与深度拔管后围手术期呼吸并发症的发生率无差异。仅体重≤14 kg与围手术期呼吸并发症增加相关。
