Oxygen saturation level in children with adenotonsillectomy as a predictive factor for safe hospital discharge
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The present study was designed to verify constitutional and preoperative lowest oxygen saturation (02Sa) as predictors for the possibility of postoperative (PO) low 02Sa 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 02Sa 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 02Sa was re-evaluated and patients had 02Sa <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 02Sa >95% on room air were discharged on the next morning, while those had 02Sa<95% continued follow-up till adjustment of their 02Sa. Results: Mean preoperative lowest 02Sa 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 02Sa in snorers group was significantly higher compared to preoperative saturation. Twenty- six patients of snorers (7.6%) developed deterioration of their nocturnal OgSa and had significantly lower mean PO lowest 02Sa compared to their preoperative 02Sa. 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 02Sa monitoring. The receiver operating characteristic (ROC) curve analysis defined the low preoperative lowest 02Sa and high BM1 as specific predictors, while young age as sensitive predictor for PO- 02 desaturation. Conclusion: The presence of high BMI of young snorer children assigned for adenotonsillectomy necessitate preoperative pulse oximetry estimation of 02Sa and patients had 02Sa <90% must be kept under observation on the r PO night for fear of development of PO- 0 desaturation that showed a frequency of 7.6% in snorers.