Abstract

LULE MORALES, MARÍA SILVIA et al. COMPLICACIONES Y FACTORES DE RIESGO ASOCIADOS A MORBIMORTALIDAD EN PACIENTES PEDIÁTRICOS QUE SON OPERADOS DE ADENOAMIGDALECTOMÍA CON SÍNDROME DE APNEA OBSTRUCTIVA DEL SUEÑO. Rev. Inst. Nal. Enf. Resp. Mex. [online]. 2004, vol.17, n.3, pp.173-180. ISSN 0187-7585.

Background: It is very important to recognize in pediatric patients with OSAS and adenotonsilar hypertrophy the severity of the apnea/hypoapnea index and SpO₂ desaturation during REM sleep, because, in case of surgical intervention, non-pharmacologic medical treatment with CPAP or Bilevel positive pressure ventilation will be necessary prior to surgery to dismiss perioperative complications. Methods: Observational, cohort, longitudinal, descriptive and prospective study. We included 124 children under 15 years of age in postsurgical period, who were admitted to IRCU between June 2000 and August 2001. We applied Fisher's exact test, Chi square, logistic progression and CI value of 95%. Result: Gender relation was M/F: 2:1, boys being more affected. The youngest patients were 13 months and the oldest 168 months; weight in kilograms was 25±9.9; percentages of associated comorbility were: obesity 26.6%, asthma 8.9% and 3.2% for neurological disorders. OSAS severity percentages were: 62.1% for mild; 21% for moderate and 16.9% for severe. Mean apnea index was 21.6 (SD32.7; min 1.3 max 175/hour). Perioperative complications were: systemic arterial hypertension, 6.5%; weaning failure, 4.8%; strider, wheezing and AMV: 9.7%; in addition, 4% of the patients with SAH needed vasodilatation intravenous therapy and analgesic. Univariate analyses showed strong association of morbidity with obesity (p>0.08), weaning failure in the OR and other trans-operative complications (p<0.002), and comorbility (p<0.017). Conclusions: Postoperative cardiovascular and respiratory complications of adeno-amygdalectomy were common (23%) in these OSAS patients compared to children without OSAS. Comorbility was strongly associated with perioperative complication. Treatment with CPAP or Bilevel positive pressure ventilation before surgical intervention decreased respiratory and cardiovascular complications.

Keywords : Adenotonsilar hypertrophy; OSAS (obstructive sleep apnea syndrome); surgical complications; intensive respiratorycare unit (IRCU).