Perioperative management of children with obstructive sleep apnea-hypopnea syndrome accompanied by pulmonary hypertension

Objective To determine the appropriate perioperative management of children with obstructive sleep apnea-hypopnea syndrome accompanied by pulmonary hypertension.Methods Two children with obstructive sleep apnea-hypopnea syndrome accompanied by pulmonary hypertension were admitted to our department from April 2006 to May 2009;their cases were analyzed and relevant literature was reviewed.Conventional adenotonsillectomy was performed for one child before controlling pulmonary hypertension.The other child received preoperative continuous positive airway pressure ventilation,then coblation-assisted adenotonsillectomy was performed.Results The child who had received preoperative continuous positive airway pressure ventilation underwent an uneventful operation;no intra-or postoperative complications were reported.In contrast,the child who did not receive preoperative pulmonary hypertension control experienced severe hypoxemia recurrently after surgery,leading to difficulty of extubation.The child remained in the intensive care unit for two days before being transferred to the general ward.The two children were followed up for more than three months and both showed improved sleeping with less snoring,open mouth breathing,and dyspnea.Preoperative apnea-hypopnea indices were 90.0 and 29.2,and postoperative apnea-hypopnea indices were 3.5 and 4.6 for the children.Lowest nocturnal oxygen saturation also improved after surgery for both children(0.43 and 0.63 vs 0.95 and 0.92).Conclusion Pulmonary hypertension is a rare but severe complication of obstructive sleep apnea-hypopnea syndrome in children.It can result in severe consequences or even death if not appropriately managed.Surgery is the first-line treatment for children with this syndrome who have enlarged tonsils and adenoids;however,the risk is considerable when accompanied by pulmonary hypertension,and incidence of complications is high.Thus,perioperative management with continuous positive airway pressure ventilation to control pulmonary hypertension is critical.