The safety of preoperative sedation in children with sleep-disordered breathing

Abstract

Objective: To prospectively monitor children who received preoperative sedation with midazolam hydrochloride prior to adenotonsillectomy (T&A) for treatment of sleep-disordered breathing with continuous pulse-oximetry to detect potential respiratory compromise.

Design: Prospective, observational study.

Setting: Hospital-based pediatric otolaryngology practice.

Patients: Seventy children, aged 1-12 years, diagnosed with sleep-disordered breathing by clinical evaluation or polysomnography (PSG), with a median RDI of 14.25, undergoing T&A.

Methods: Children underwent a standardized anesthesia protocol including preoperative oral midazolam hydrochloride 0.5mg/kg, standard American Society of Anesthesiologists (ASA) monitoring, mask induction with sevoflurane, muscle relaxant with reversal if indicated, and intravenous dexamethasone sodium phosphate 0.5mg/kg. Children were monitored in the hospital until discharge criteria were met. Selected children with severe OSA were monitored overnight on the pediatric floor or the pediatric intensive care unit. Adverse respiratory events were defined as upper airway obstruction, hypoventilation, desaturation, bradycardia, or sustained lethargy.

Main outcome measures: Incidence of pre and postoperative obstructive complications.

Results: During the study period only two patients (2.9%) had a measurable adverse event directly related to the administration of the sedation.

Conclusion: Based on sporadic reports of adverse airway events in children with obstructive sleep apnea receiving sedation, these children frequently do not receive preoperative sedation. Given the low morbidity of preoperative sedation in our population, many children with sleep-disordered breathing may safely be pre-medicated.