[Perioperative managements of a mentally retarded child with obstructive sleep apnea syndrome for adeno-tonsillectomy].

We describe a mentally retarded child with obstructive sleep apnea syndrome (OSAS) in whom it was difficult to maintain upper airway in the perioperative period. The child underwent awake intubation, because the preanesthetic evaluation of the airway with a direct fiberoptic visualization revealed a very narrow airway. Also we considered that if we used an anesthetic agent, a perioperative airway management would be very troublesome. Postoperatively we continuously monitored for apnea and arrhythmias. When the child was sleeping, we found frequently that her thoratic movements were getting weak and percutaneous oxygen saturation went down to about 70 percent. The preoperative direct fiberoptic visualization of the upper airway is effective for the evaluation of the degree of airway obstruction in this child. We also recommend the continuous intensive postoperative monitorings including pulse oximetry, ECG, and apnea monitor which are very important to avoid life-threatening complications such as upper airway obstruction and serious arrhythmias in patients with obstructive sleep apnea syndrome.