Oxygen saturation level in children with adenotonsillectomy as a predictive factor for safe hospital discharge
Yasser Haroon1 and Yehia Hamed2
Departments of Otorhinolaryngology1 & Pediatrics2, Faculty of Medicine, Benha University, Egypt
Abstract: Objectives: The present study was designed to verify constitutional and preoperative lowest oxygen saturation (O2Sa) as predictors for the possibility of postoperative (PO) low O2Sa that necessitates interference and to identify patients to be managed on out-patient or in-patient basis. Patients & Methods: The study included 512 children; 340 (66.4%) were habitual snorers and 172 (33.6%) were non-snorers. All patients underwent determination of demographic data including age, sex, weight, height and body mass index (BMI). The night prior to surgery, pulse oximetry was performed for estimation of O2Sa and was scored according to Levy scoring system. Adenotonsillectomy was conducted under general inhalational anesthesia. All patients were managed postoperatively at the in-patients ward for occurrence of surgery-related immediate PO complications. PO O2Sa was re-evaluated and patients had O2Sa <90% were identified. The need for the insertion of oro-pharyngeal airway, continuous positive airway pressure or endotracheal intubation and mechanical ventilation was noted. Patients passed their night free with O2Sa >95% on room air were discharged on the next morning, while those had O2Sa<95% continued follow-up till adjustment of their O2Sa. Results:Mean preoperative lowest O2Sa was significantly lower in snorers compared to non-snorers and patients' distribution among higher scoring grades showed significant difference in favor of non-snorers. Mean PO lowest O2Sa in snorers group was significantly higher compared to preoperative saturation. Twenty- six patients of snorers (7.6%) developed deterioration of their nocturnal O2Sa and had significantly lower mean PO lowest O2Sa compared to their preoperative O2Sa. Three patients required endotracheal intubation and mechanical ventilation; 6 patients required insertion of oro-pharyngeal airway with nostril tube oxygenation at pediatric ward for 1-hr and 19 patients were kept under observation with continuous O2Sa monitoring. The receiver operating characteristic (ROC) curve analysis defined the low preoperative lowest O2Sa and high BMI as specific predictors, while young age as sensitive predictor for PO- O2 desaturation. Conclusion: The presence of high BMI of young snorer children assigned for adenotonsillectomy necessitate preoperative pulse oximetry estimation of O2Sa and patients had O2Sa <90% must be kept under observation on the 1st PO night for fear of development of PO- O2 desaturation that showed a frequency of 7.6% in snorers.
[Yasser Haroon and Yehia Hamed. Oxygen saturation level in children with adenotonsillectomy as a predictive factor for safe hospital discharge. J Am Sci 2013;9(6):586-592]. (ISSN: 1545-1003).http://www.jofamericanscience.org. 74
Key words: Oxygen saturation, Snorer, Hospital discharge. Full Text 74