Introduction
It has been reported that 6% of children with obstructive sleep apnea (OSA) experience perioperative complications. The overall respiratory complication rate was found to be 2.4% and the breakdown was as follows: laryngospasm/bronchospasm (0.6%), pneumonia (1.3%), postoperative lung edema (0.6%), and other respiratory complications (1.3%).[1,2] It is generally believed that the degree of preoperative pulmonary dysfunction has a significant influence on the incidence of perioperative pulmonary complications. Adenotonsillar hypertrophy is the main cause of pediatric OSA, and it can directly lead to a decline in lung function.[3] When accompanied by allergic rhinitis, bronchial asthma, and other airway inflammatory diseases, the decrease of pulmonary function is more obvious.[4,5] Abnormal lung function can objectively reflect airway hyper-responsiveness, which is associated with an increased risk for adverse airway events in children undergoing surgery.[6] Furthermore, decreased lung function can increase the risk for lung infections caused by weakened respiratory movements and obstructed airway secretions after an adenotonsillectomy.[7]
Perioperative airway management, including preoperative use of positive pressure ventilation, and/or difficult intubation anesthesia implement mask ventilation, use of protective ventilation, morphine reserved strategy and half sitting position, and close monitoring after surgery, can reduce lung complications, patient mortality, readmission rates, and medical expenditures.[8-10 ] The current preoperative airway assessment of OSA patients focuses on whether it is a difficult airway, and there are few reports on whether preoperative pulmonary function assessment and intervention can effectively reduce perioperative complications in OSA patients. The worse the preoperative pulmonary function, the more postoperative pulmonary complications.[11]Therefore, it is beneficial to know how to avoid the risk for abnormal lung function so as to reduce the risk for airway complications associated with an adenotonsillectomy in children with OSA. This study was conducted to screen pediatric OSA patients with abnormal lung function and to establish an optimized preoperative airway management process that might promote a rapid improvement in lung function prior to surgery.