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. |
