부산대학교 도서관

Background Children who undergo adenotonsillectomy for sleep-disordered breathing frequently have postoperative oxygen desaturations. Nocturnal hypoxia has been shown to predict postoperative respiratory complications; however, other gas exchange abnormalities detected on polysomnography ( PSG) have not been evaluated. Aim We sought to determine whether hypercapnia seen on preoperative nocturnal PSG can predict postoperative hypoxemia. Methods We conducted a retrospective review of 319 children who underwent polysomnography before adenotonsillectomy. Saturation levels were recorded for at least 2 h postoperatively, and the primary outcome was desaturation (<90%). Results The median patient age was 5 years (range, 5 months-17 years). Patients who desaturated postoperatively had higher median peak endtidal CO2 (Et CO2) levels (55.5 vs 52 mmHg; P = 0.02), lower saturation nadirs (80.5% vs 88%; P = 0.048), and were younger (2 vs 6 years; P < 0.001) than those without desaturation. Age was significantly correlated with peak Et CO2 ( r = −0.16), respiratory disturbance index ( RDI; r = −0.23), and oxygen saturation nadir ( r = 0.25; all P < 0.01). In unadjusted analysis, age <3 years compared to ≥9 years (odds ratio [ OR] = 10.09; 95% confidence interval [ CI] = 2.13-96.26), peak Et CO2 > 55 mmHg ( OR = 3.38; 95% CI = 1.21-9.47), and RDI ≥ 10 ( OR = 2.89; 95% CI = 1.05-8.42) were associated with increased odds of desaturation. Multivariable logistic regression on age, race, sex, peak Et CO2, RDI, opioid use, and saturation nadir showed that only age was significantly associated with postoperative desaturation. Patients 0-2 years old were 10.43 (95% CI = 1.89-110.9) times more likely to have desaturation than patients 9-17 years old. Conclusion Patients <3 years of age are most likely to have postoperative hypoxemia after adenotonsillectomy. Gas exchange abnormalities did not correlate with postoperative desaturations, although age and peak Et CO2 did strongly correlate. [ABSTRACT FROM AUTHOR]