TY - JOUR
T1 - Sleep disordered breathing may signal laryngomalacia
AU - Clark, Christine M.
AU - DiSalvo, Dale S.
AU - Prozesky, Jansie
AU - Carr, Michele
N1 - Publisher Copyright:
© 2017 Clark et al.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background: Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy. Aim: To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy. Methods: Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications. Results: 94.5% of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2%, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P=0.023). 57.8% had vocal cord edema. 75.3% of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4% of patients, and 15.7% underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy. Conclusion: A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.
AB - Background: Pediatric anesthesiologists are often confronted with children with sleep-disordered breathing (SDB) presenting for tonsillectomy and/or anesthesia. The typical patient has symptoms of obstructive sleep apnea (OSA) with enlarged tonsils; however, a subset of patients may have underlying laryngomalacia (LM) without tonsillar hypertrophy. Both OSA and LM significantly increase the risk of intra- and postoperative airway obstruction and sensitivity to narcotics. The prevalence of LM may be underestimated, because direct laryngoscopy (DL) is not routinely performed in the diagnostic evaluation of patients with SDB who lack tonsillar hypertrophy. Aim: To identify the prevalence and DL findings in pediatric patients with SDB without tonsillar hypertrophy. Methods: Retrospective chart review of 108 patients with SDB who underwent general anesthesia for adenotonsillectomy (TA) or adenoidectomy with concomitant DL. The following data were collected: demographic information, medical comorbidities, polysomnography results, anesthetic techniques, and postoperative complications. Results: 94.5% of children had DL findings consistent with LM, including a retropositioned epiglottis and short aryepiglottic folds. Postglottic edema was observed in 42.2%, and these patients were significantly more likely to have a diagnosis of gastroesophageal reflux (P=0.023). 57.8% had vocal cord edema. 75.3% of children who received routine postoperative follow-up care experienced complete symptom resolution. Postoperative complications following discharge from hospital occurred in 12.4% of patients, and 15.7% underwent supraglottoplasty for continued SDB symptoms after TA or adenoidectomy. Conclusion: A substantial proportion of patients with SDB who lacked tonsillar hypertrophy had findings consistent with LM, suggesting that the larynx may be the primary site of upper airway obstruction in these patients. This has significant implications in terms of perioperative management. The majority of patients with SDB had symptomatic improvement following TA or adenoidectomy; however, a subset required further surgical intervention with supraglottoplasty.
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U2 - 10.2174/1874321801711010068
DO - 10.2174/1874321801711010068
M3 - Review article
AN - SCOPUS:85030757534
SN - 1874-3218
VL - 11
SP - 68
EP - 74
JO - Open Anesthesiology Journal
JF - Open Anesthesiology Journal
ER -