Pediatric obstructive sleep apnea revisited: Perioperative considerations for the pediatric Anesthesiologist

• Published in: International journal of pediatric otorhinolaryngology Vol. 139; p. 110420
• Main Authors: Chandrakantan, Arvind, Mehta, Deepak, Adler, Adam C.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.12.2020
• Subjects: Adenoidectomy; Anesthesiologists; Child; Humans; Obstructive sleep apnea; Pediatrics; Polysomnography; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - surgery; Sleep disordered breathing; Tonsillectomy - adverse effects; Pediatrics; Polysomnography; Obstructive sleep apnea; Sleep disordered breathing
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2020.110420

Pediatric obstructive sleep apnea presents in up to 7% of children and represents a constellation from nasal turbulence to cessation in gas exchange. There are numerous end organ sequelae including neurocognitive morbidity associated with persistent OSA. Adenotonsillectomy (AT), the first line therapy for pediatric OSA, has not been demonstrated to reduce all end organ morbidity, specifically neurological and behavioral morbidity. Furthermore, certain at-risk populations are at higher risk from neurocognitive morbidity. Precise knowledge and perioperative planning is required to ensure optimal evidence-based practices in children with OSA. This comprehensive review covers the seminal perioperative implications of OSA, including preoperative polysomnography, pharmacotherapeutics, and postoperative risk stratification.