Feasibility of performing measurements of airway collapse during tonsillectomy surgery in children.

None listed

Obstructive sleep apnoea (OSA) is a condition involving repeated episodes of partial or complete blockage of the airway during sleep. Learning difficulties, behavioural problems as well as bed-wetting, sleep-walking, retarded growth, other hormonal and metabolic problems and even failure to thrive can be related to sleep apnoea. Children diagnosed with OSA usually undergo surgical removal of the tonsils and adenoids. However, there is a high rate of complications with approximately 50% of the children suffering from minor or major breathing problems during and/or after surgery requiring specialised care. Additionally, the younger the children are, the higher the risk of breathing problems, which have a potential for serious harm to their health. The impact on the healthcare system is significant; the number of unplanned admissions necessitating specialised treatment with prolonged hospital stays increases causing delays on theatre lists. This leads to potential cancellations of other children due to the lack of theatre time and consequently increases the waitlist time. Currently the pre-operative assessment by the ENT surgeon determines whether the child will be managed as a day case or a ward patient. In case of the latter, it is further distinguished if the child gets normal ward care, specialised ward care or whether an admission to the intensive care unit is required. If the child has not been sent to the preoperative anaesthetic clinic (which is the case for the majority of children), the anaesthetist on the day of surgery might need to organise more specialised care if he/she does not agree with the care pre-organised, which may lead again to cancellations. Currently, preoperative assessment relies heavily on the surgeons and the anaesthetists’ pre-operative diagnosis. It usually involves using a clinical questionnaire that relies mostly on parental observation and interpretation of symptoms to accurately identify the presence of OSA and grade its severity accordingly. Once the grade of OSA has been established, the risk of perioperative respiratory complications can be better established and preventative strategies can be implemented where deemed necessary. However the rate of complication and unplanned admissions remain high. This is due to the grading of OSA being impacted by the high variability in the answers to the clinical questionnaire; different parents interpret the same symptoms differently and thus introduce a high bias in the OSA grading. A more appropriate approach to diagnosis and grading OSA with a much higher degree of accuracy would be the use of a scientific marker that can easily, quickly and safely be measured at the point of care. It is well known and has been shown in the literature that children with OSA have upper airways that are more prone to collapse during sleep and thus anaesthesia. Thus measuring the propensity of upper airway collapse may provide the treating team with more accurate physiological data to grade OSA and consequently narrow down the variability in the estimated probability of perioperative respiratory adverse events. Our team of respiratory and sleep physiology experts have developed and trialled a quick, safe and easy technique to measurement the propensity of upper airway collapsibility in adults and with this study we are aiming to identify whether this technique can be used in everyday clinical practice during peri-operative management to screen children with OSA who are at a higher risk of perioperative respiratory adverse events (PRAE).

No related papers found yet.