September 19, 1996
Media Contact: Debbie Bangledorf
Phone: (410) 223-1731
Researchers at the Johns Hopkins Children's Center concluded that not all children need to stay in an intensive care unit overnight after tonsil and adenoid surgery to relieve mild obstructive sleep apnea.
Mark Helfaer, M.D., the lead author, says the study shows some children with mild obstructive sleep apnea can receive immediate care in a recovery room or short-stay setting following surgery. Other recent studies show it seems safe to discharge routine tonsil and adenoid patients six hours after an uneventful surgery. However, the family and health care staff should communicate about any problems with postsurgical bleeding, pain, sleeping difficulties, or analgesic administration.
"Kids recover better surrounded by the familiarity and comforts of home," says Helfaer, associate professor of anesthesiology/critical care medicine and pediatrics at the Children's Center. "With this information, we may be able to lower the number of admissions to the intensive care unit, thus reducing costs."
Until now, some sleep apnea patients have been admitted to pediatric intensive care unit settings for monitoring because physicians feared the condition could worsen on the first night after surgery or anesthesia, leading to airway swelling or respiratory difficulties.
The study was published in a recent issue of the Journal of Critical Care Medicine.
More than 250,000 adenotonsillectomies are performed each year around the country to relieve obstructive sleep apnea, a condition that results in airway obstruction, daytime sleepiness, nighttime sleep difficulty, hyperactivity, and learning difficulties. Removal of tonsils and adenoids has been shown to reduce the obstruction and symptoms within six months of surgery.
Study participants were healthy children with no medical complications in addition to their mild sleep apnea. Fifteen patients, ages 1 to 18, who had less than 15 sleep apnea events per hour, had no cardiac, craniofacial, or weight gain abnormalities, were selected to participate. After surgery, patients were monitored in the pediatric intensive care unit. One group received narcotics for pain relief and the other received only acetaminophen, a milder pain medication with fewer side effects. Heart rate, blood pressure, respiratory rate, and oxygen saturation were monitored.
Results showed that there were no differences in the two groups in terms of pain relief, blood loss, and the time lapse from surgery to the recovery room. The number of obstructive apnea events per hour decreased postoperatively. None of the patients required oxygen administration, and the type of medication given postoperatively did not exceed normal amounts.
Co-authors of the study were Susanna McColley, M.D.; Paula Pyzik, R.Psg.T.; David Tunkel, M.D.; David Nichols, M.D., F.C.C.M.; Fuad Baroody, M.D.; Max April, M.D.; Lynne Maxwell, M.D.; and Gerald Loughlin, M.D., all staff at Hopkins. Funding was provided by the Children's Center's pediatric clinical research unit.
The Johns Hopkins Children's Center is the children's hospital of The Johns Hopkins Medical Institutions. Maryland's most comprehensive acute-care hospital for children, the Center, with its 177-bed hospital and more than 40 divisions and services, treats some 8,000 inpatients annually, with more than 90,000 outpatient visits.