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PEDIATRIC ANESTHESIA

Ventilatory Response to CO₂ in Children with Obstructive Sleep Apnea from Adenotonsillar Hypertrophy

Susan G. Strauss, MD^*,, Anne M. Lynn, MD^*,, Susan L. Bratton, MD^*,, and Mary Kay Nespeca, RN, BSN

*Department of Anesthesiology, University of Washington School of Medicine; and Department of Anesthesia and Critical Care, Children’s Hospital and Medical Center, Seattle, Washington

Address correspondence to Susan G. Strauss, MD, Department of Anesthesia and Critical Care, Children’s Hospital and Medical Center, P.O. Box 5371, Seattle, WA 98105.

We measured the ventilatory response to CO₂ as an indicator of respiratory control dysfunction in children with obstructive sleep apnea (OSA) scheduled for adenotonsillectomy. Measurements were performed in unpremedicated children via an endotracheal tube under 0.4%–0.5% end-tidal halothane anesthesia. Mean ventilatory CO₂ response slopes for 11 children with OSA requiring adenotonsillectomy (Group I) were compared with those for 14 children without OSA requiring adenotonsillectomy (Group II) and 15 children without OSA requiring nonairway surgery (Group III). The mean ventilatory slope corrected for body surface area for Groups I, II, and III were 539 ± 338, 828 ± 234, and 850 ± 380 mL · min^-1 · mm Hg ETCO₂^-1 · m^-2, respectively (P < 0.05, Group I versus Groups II and III). Historical data—including snoring, apneic episodes >10 s, daytime hypersomnolence, and nocturnal enuresis—defined those with OSA. Obesity occurred more frequently in patients with OSA and with depressed ventilatory responses (P < 0.001). Children with OSA from adenotonsillar hypertrophy have a diminished ventilatory response to CO₂ stimulation, compared with those without OSA symptoms. The depressed response may account, in part, for the reported increased risk of perioperative respiratory complications in this population.

Implications: Children with obstructive sleep apnea undergoing adenotonsillar surgery are at risk of postoperative respiratory compromise. We found that patients with a clinical history suggesting obstructive sleep apnea have a diminished ventilatory response to CO₂ rebreathing, compared with controls.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999