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Obstructive sleep apnoea adenotonsillectomy in children: when to refer to a centre with a paediatric intensive care unit?

Published online by Cambridge University Press:  03 April 2007

E J S M Blenke ,
A R Anderson ,
Hemal Raja ,
S Bew  and
L C Knight
E J S M Blenke*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, The General Infirmary at Leeds, Leeds, UK
A R Anderson
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, The General Infirmary at Leeds, Leeds, UK
Hemal Raja
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Hull Royal Infirmary, Hull, UK
S Bew
Affiliation:
Department of Anaesthesia, The General Infirmary at Leeds, Leeds, UK
L C Knight
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, The General Infirmary at Leeds, Leeds, UK
*
Address for correspondence: Ross Anderson, 33 Lock Keepers Court, Victoria Dock, Hull, HU9 1QH, UK. E-mail: ara@doctors.net.uk
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Abstract

Objective:

To identify regional surgical referral patterns for adenotonsillectomy in children with obstructive sleep apnoea to our tertiary centre with paediatric intensive care unit facilities and to establish guidelines for elective paediatric intensive care unit referral and admission.

Methods:

Two methods were used. A questionnaire was sent to ENT consultants in five surrounding hospitals with no in-house paediatric intensive care facilities. The second was a prospective observational study undertaken in our tertiary centre for a sub-set of patients undergoing obstructive sleep apnoea adenotonsillectomy between January 2002 and February 2005. These children were considered high risk as judged clinically by an ENT surgeon. Most had obstructive sleep apnoea and a co-morbidity. Otherwise healthy children with simple obstructive sleep apnoea were excluded.

Results:

15 out of 20 consultants responded to the questionnaire. Four referred on the grounds of clinical history, five referred based on pulse oximetry, nine referred syndromal children and four did not refer electively. Of the 49 high risk patients operated on, only 12 required paediatric intensive care admission with no emergency paediatric intensive care admissions. No otherwise healthy children with uncomplicated obstructive sleep apnoea symptoms required paediatric intensive care admission during the study period.

Conclusion:

There was no regional consensus regarding paediatric intensive care unit referral for obstructive sleep apnoea adenotonsillectomy. Clinical judgement without complex sleep studies by those experienced in this area was sufficient to detect complicated cases of obstructive sleep apnoea with co-morbidity requiring paediatric intensive care.

Keywords

Obstructive Sleep Apnoea, ChildAdenoidectomyTonsillectomyIntensive Care
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 1 , January 2008 , pp. 42 - 45
Copyright
Copyright © JLO (1984) Limited 2007

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Footnotes

Presented in poster format at the North of England Otolaryngology Society Meeting, Wakefield, 17th September 2005.

The 46th Annual meeting of the Irish Otolaryngological Head and Neck society, Westport, Republic of Ireland, 8th October 2007.

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