Scalzitti Nicholas J, Sarber Kathleen M
Departments of Otolaryngology and Sleep Medicine, San Antonio Military Medical Center, San Antonio, Texas.
Department of Pulmonary Medicine, Sleep Disorders Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Paediatr Anaesth. 2018 Nov;28(11):940-946. doi: 10.1111/pan.13506. Epub 2018 Oct 3.
Sleep-disordered breathing has a prevalence of 12% in the pediatric population. It represents a spectrum of disorders encompassing abnormalities of the upper airway that lead to sleep disruption, including primary snoring, obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. Sleep-disordered breathing is the most common indication for adenotonsillectomy, one of the most common procedures performed in children. In recent years, the American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, and the American Society of Anesthesiologists have crafted guidelines to help safely manage children with sleep-disordered breathing. Each organization recommends in-laboratory polysomnography for definitive diagnosis of obstructive sleep apnea in certain cases. However, because this test is both costly and inconvenient, there has been significant interest in alternative methods for diagnosing clinically significant sleep-disordered breathing. Accurate diagnosis is critical because sleep-disordered breathing confers certain perioperative risks and increased mortality in some instances. Recent studies have elucidated the danger of anesthesia and opioids in worsening obstructive sleep apnea, and recommendations for alternative analgesia are being created. In addition, determining the most appropriate level and duration of monitoring in the postoperative period is actively being evaluated. This article presents an overview of the recent literature on the perioperative care of pediatric patients with sleep-disordered breathing. It highlights innovative modalities and limitations in diagnosing obstructive sleep apnea, the importance of a tailored anesthetic/analgesic approach to children with obstructive sleep apnea, and the need for postoperative monitoring. It also brings to focus that further studies on the perioperative care of these children are necessary.
睡眠呼吸障碍在儿科人群中的患病率为12%。它代表了一系列疾病，包括上呼吸道异常导致睡眠中断的各种病症，如原发性打鼾、阻塞性睡眠呼吸暂停、中枢性睡眠呼吸暂停和与睡眠相关的通气不足。睡眠呼吸障碍是腺样体扁桃体切除术最常见的指征，而腺样体扁桃体切除术是儿童最常见的手术之一。近年来，美国耳鼻咽喉头颈外科学会、美国儿科学会和美国麻醉医师协会制定了指南，以帮助安全管理患有睡眠呼吸障碍的儿童。每个组织都建议在某些情况下进行实验室多导睡眠图检查，以明确诊断阻塞性睡眠呼吸暂停。然而，由于这项检查既昂贵又不方便，人们对诊断具有临床意义的睡眠呼吸障碍的替代方法产生了浓厚兴趣。准确的诊断至关重要，因为睡眠呼吸障碍在某些情况下会带来一定的围手术期风险并增加死亡率。最近的研究阐明了麻醉和阿片类药物在加重阻塞性睡眠呼吸暂停方面的危险，并且正在制定替代镇痛的建议。此外，目前正在积极评估术后最合适的监测水平和持续时间。本文概述了近期关于患有睡眠呼吸障碍的儿科患者围手术期护理的文献。它强调了诊断阻塞性睡眠呼吸暂停的创新方法和局限性、针对阻塞性睡眠呼吸暂停儿童采用量身定制的麻醉/镇痛方法的重要性以及术后监测的必要性。它还强调有必要对这些儿童的围手术期护理进行进一步研究。
