SELECTED RISK-FACTORS IN PEDIATRIC ADENOTONSILLECTOMY

Objective: To evaluate the ability of a set of cost-effective criteria to identify before surgery the pediatric patients in whom perioperati ve respiratory compromise is most likely to develop after adenotonsill ectomy. Setting: A children's hospital medical center. Design: Prospec tive study using preoperative parental questionnaires and perioperativ e respiratory status documentation. Patients: All patients scheduled a t the outpatient clinic were eligible. Main Outcome Measure: The devel opment of respiratory compromise as defined by at least 1 of the follo wing occurring more than 2 hours after surgery: an oxygen desaturation level of less than 90%, an obstructive breathing pattern, or respirat ory distress requiring intervention. Results: The risk of respiratory compromise was significantly increased in patients who were younger th an 3 years (P<.001) and in those who had neuromuscular disorders (P<.0 5), chromosomal abnormalities (P<.005), difficulty in breathing during sleep (P<.005), restless sleep (P<.01), loud snoring with apnea (P<.0 5), or an upper respiratory tract infection within 4 weeks of surgery (P=.005). Respiratory compromise did not develop in any patients who d id not snore (P<.05). Conclusions: A complete history that includes sy mptoms suggestive of sleep apnea will assist in the preoperative ident ification of pediatric patients most at risk for perioperative respira tory compromise after undergoing adenotonsillectomy. Such patients mig ht benefit from overnight observation in a hospital setting. However, when snoring is absent, outpatient surgery is appropriate, as the risk of respiratory compromise is minimal.