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Children with severe OSAS who have adenotonsillectomy in the morning are less likely to have postoperative desaturation than those operated in the afternoon

[Les enfants atteints d’un SAOS sévère, opérés pour amygdalectomie le matin, sont moins susceptibles de désaturation postopératoire que les opérés d’après-midi]

Albert Koomson, MD^*, Isabelle Morin, MSC, Robert Brouillette, MD and Karen A. Brown, MD^*

^* From the Departments of Anesthesia,
and Pediatrics, Montreal Children’s Hospital;
and the Biostatistics Laboratory, McGill University Health Centre Research Institute, Montreal, Quebec, Canada.

Address correspondence to: Dr. Karen A. Brown, McGill University Health Centre/Montreal Children’s Hospital, Division of Pediatric Anesthesia, 2300 Tupper Street, Room C-1118, Montreal, Quebec H3H 1P3, Canada. Phone: 514-412-4463; Fax: 514-412-4341; E-mail: roula.cacolyris{at}muhc.mcgill.ca

Purpose: To determine, in a subset of children previously reported, if the time of day when adenotonsillectomy for severe obstructive sleep apnea syndrome (OSAS) was performed affected the incidence of postoperative respiratory complications.

Clinical features: Children having adenotonsillectomy were included if they had a polysomnographic diagnosis of severe OSAS within six months prior to operation. Patients who met the inclusion criteria were grouped by the occurrence of postoperative desaturation into a saturated (SAT) and desaturated (deSAT) group. The charts of children in group deSAT were reviewed. The clock time of the surgical procedure was recorded and categorized as morning (AM) or afternoon (PM).

Results: Eighty-eight patients met the inclusion criteria. There were 31 girls and 57 boys. The mean ± SD age (yr) and weight (kg) were 4.6 ± 2.9 yr and 20.8 ± 14.5 kg respectively. There were 63 children in the SAT group and 25 in the deSAT group. Differences in age, weight and gender were not significant. The preoperative oxygen saturation (SaO₂) nadir for the SAT and deSAT groups was 80.8 ± 10.2% and 67.6 ± 17.5% (P < 0.05) respectively. The preoperative obstructive apnea and hypopnea index was 15.8 ± 10.2 and 35.7 ± 34.6 events•hr^-1 (P < 0.05), respectively. Surgery in 63 (71.6%) children was performed in the AM. Univariate logistic regression identified PM surgery [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.7 to 12.6, P = 0.002] and a preoperative SaO₂ nadir < 80% (OR 3.6, 95% CI 1.4 to 9.4, P = 0.009) as risk factors predicting postadenotonsillectomy desaturation.

Conclusion: Children with severe OSAS whose surgery is performed in the AM are less likely to desaturate following adenotonsillectomy than children whose surgery is performed in the PM.

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