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.