Airway management process
An otolaryngologist together with an allergist conducted a preoperative airway evaluation and then established an intervention process for each child with OSA based on their lung function test (Figure 1 ). In brief, we screened out patients based on their lung function test for that general anesthesia with tracheal intubation can elicit life-threatening bronchospasm in patients with bronchial hyperreactivity, and increased airway responsiveness is associated with an enhanced risk for respiratory symptoms and accelerated decline in FEV1.[18] Therefore, an abnormal FEV1% were considered as risk factor for airway complications. Patients with a FEV1% pre value < 80% were given the atomized drugs at different frequencies according to the severity of their abnormal lung function. Atomization inhalation of 1 mg budesonide, 0.25 mg ipratropium, and 2.5 mg terbutaline was given twice a day to mild patients and three times a day to moderate and moderate-severe patients. The exclusion criterion for preoperative airway risk was determined based on the patient’s improvement in lung function after intervention.