Is sedation safe during dynamic sleep fluoroscopy of children with obstructive sleep apnea?

OBJECTIVE. Airway compromise is considered a relative contraindication for pediatric sedation. This contraindication presents a paradoxical problem wh en patients require sedation in preparation for imaging performed to evalua te the cause of airway obstruction. We use dynamic sleep fluoroscopy in the evaluation of children who have obstructive sleep apnea. The purpose of th is study was to evaluate the success and safety of a structured sedation pr ogram for dynamic sleep fluoroscopy. MATERIALS AND METHODS. Eighty consecutive dynamic sleep fluoroscopic studie s were evaluated. The type of sedation used, success rate, complications re lated to the sedation, and characteristics of the children studied were rev iewed. Patients were sedated in accordance with our departmental sedation p rogram guidelines. Findings on fluoroscopy were correlated with episodes of oxygen desaturation or noisy breathing, RESULTS. In all 80 cases, dynamic sleep fluoroscopy was successfully perfor med. Seventy-two studies were Pei-formed, with sedation supervised by the r adiologist. Four patients fell asleep without sedation. In four patients, s edation was performed by an anesthesiologist (preprocedural decision). Sixt y-four children (80%) had complex medical problems, and 39 (49%) had a hist ory of previous airway surgery. All studies were considered successful. Spe cific diagnoses were identified in 66 children (83%). No children suffered complications or required tracheal intubation. CONCLUSION. Children with airway compromise who are being evaluated for obs tructive sleep apnea can be successfully and safely sedated for dynamic sle ep fluoroscopy when a structured sedation program is used.