An audit of the use of an opiate sparing, multimodal analgesic regime in children with sleep disordered breathing/obstructive sleep apnoea undergoing adenotonsillectomy

摘要

Objectives: Children with Sleep Disordered Breathing/Obstructive Sleep Apnoea have an increased incidence of respiratory complications following adenotonsillectomy. This may be partly related to an increase in sensitivity to opiates. An audit of such cases undergoing adenotonsillectomy was performed with the following aims:. 1.To measure and compare the incidence of postoperative respiratory complications following an already locally established opiate sparing, multimodal analgesic regime, with published reports.2.To measure local compliance with these guidelines.3.To consider which risk factor(s) best predicted the chances of a respiratory complication occurring, perhaps enabling a more efficient use of post operative resources in the future.4.To measure the incidence of postoperative haemorrhage and post operative nausea and vomiting. Methods: All patients had Sleep Disordered Breathing/Obstructive Sleep Apnoea confirmed preoperatively by Overnight Oximtery Studies. Oximetry data was expressed as the lowest recorded saturation (SpO2Low %) and number of significant desaturations (see text) per hour (ODI4%). Case notes and oximetry studies were scrutinized for relevant perioperative anaesthetic and analgesic data, risk factors and complications. Results: The overall incidence of major and minor respiratory complications was low (1.6% and 27% respectively). Children who suffered any complication were more likely to be younger (p=0.0078), have a lower SpO2Low (p=0.004) and higher ODI4% (p=0.0001). Multiple logistic regression showed ODI4% to be the best predictor of a potential respiratory complication (p=0.0032). An ODI4% of 8 may be the best cut off point in predicting complications (AUC=0.78, sensitivity=0.90) but it showed a poor specificity (0.57). Primary/secondary haemorrhage occurred in 0.4%/1.2% respectively and postoperative nausea and vomiting in 4.4%. Conclusions: A low dose opiate-based, multi modal analgesic regime appears to be effective and safe in children with Sleep Disordered Breathing/Obstructive Sleep Apnoea undergoing adenotonsillectomy.