Wilcox Lyndy J, Bergeron Mathieu, Reghunathan Saranya, Ishman Stacey L
Division of Pediatric Otolaryngology-Head and Neck Surgery Cincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A.
Department of Otolaryngology-Head & Neck Surgery , University of Arizona College of Medicine-Tucson Tucson Arizona U.S.A.
Laryngoscope Investig Otolaryngol. 2017 Nov 2;2(6):423-431. doi: 10.1002/lio2.118. eCollection 2017 Dec.
Drug-induced sleep endoscopy (DISE) involves assessment of the upper airway using a flexible endoscope while patients are in a pharmacologically-induced sleep-like state. The aim of this article is to review the current literature regarding the role of DISE in children with obstructive sleep apnea (OSA). The indications, typical anesthetic protocol, comparison to other diagnostic modalities, scoring systems, and outcomes are discussed.
A comprehensive review of literature regarding pediatric DISE up through May 2017 was performed.
DISE provides a thorough evaluation of sites of obstruction during sedation. It is typically indicated for children with persistent OSA after tonsillectomy, those with OSA without tonsillar hypertrophy, children with risk factors predisposing then to multiple sites of obstruction, or when sleep-state dependent laryngomalacia is suspected. The dexmedotomidine and ketamine protocol, which replicates non-REM sleep, appears to be safe and is often used for pediatric DISE, although propofol is the most commonly employed agent for DISE in adults. Six different scoring systems (VOTE, SERS, Chan, Bachar, Fishman, Boudewyns) have been used to report pediatric DISE findings, but none is universally accepted.
DISE is a safe and useful technique to assess levels of obstruction in children. There is currently no universally-accepted anesthetic protocol or scoring system for pediatric DISE, but both will be necessary in order to provide a consistent method to report findings, enhance communication among providers and optimize surgical outcomes.
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药物诱导睡眠内镜检查（DISE）是在患者处于药物诱导的类睡眠状态时，使用可弯曲内镜对上气道进行评估。本文旨在综述当前关于DISE在阻塞性睡眠呼吸暂停（OSA）儿童中作用的文献。讨论了其适应证、典型麻醉方案、与其他诊断方法的比较、评分系统及结果。
对截至2017年5月的有关儿童DISE的文献进行全面综述。
DISE可在镇静期间对阻塞部位进行全面评估。它通常适用于扁桃体切除术后仍有持续性OSA的儿童、无扁桃体肥大的OSA儿童、有多个阻塞部位危险因素的儿童，或怀疑有睡眠状态依赖性喉软化症的儿童。模拟非快速眼动睡眠的右美托咪定和氯胺酮方案似乎是安全的，常用于儿童DISE，尽管丙泊酚是成人DISE中最常用的药物。六种不同的评分系统（VOTE、SERS、Chan、Bachar、Fishman、Boudewyns）已被用于报告儿童DISE的结果，但没有一种被普遍接受。
DISE是评估儿童阻塞水平的一种安全且有用的技术。目前儿童DISE尚无普遍接受的麻醉方案或评分系统，但为了提供一致的结果报告方法、加强医疗服务提供者之间的沟通并优化手术效果，这两者都是必要的。
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