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Investigating the effect of a nasal decongestant on post-adenotonsillectomy respiratory complications in 25 paediatric patients with obstructive sleep apnoea: a pilot study

Published online by Cambridge University Press:  01 February 2019

E Shamil ,
M J Rouhani ,
A C Panayi ,
J Lynch ,
J Tysome  and
N Jonas
E Shamil*
Affiliation:
ENT Department, Cambridge University Hospitals NHS Foundation Trust, UK Specialist Registrar in Otolaryngology, London Deanery, UK
M J Rouhani
Affiliation:
Specialist Registrar in Otolaryngology, London Deanery, UK School of Clinical Medicine, University of Cambridge, UK
A C Panayi
Affiliation:
School of Clinical Medicine, University of Cambridge, UK
J Lynch
Affiliation:
Anaesthetic Department, Cambridge University Hospitals NHS Foundation Trust, UK
J Tysome
Affiliation:
ENT Department, Cambridge University Hospitals NHS Foundation Trust, UK
N Jonas
Affiliation:
ENT Department, Cambridge University Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Mr Eamon Shamil Specialist Registrar in Otolaryngology, London Deanery, UK E-mail: [email protected]
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Abstract

Objective

Adenotonsillectomy is frequently performed for obstructive sleep apnoea, but is associated with post-operative respiratory morbidity. This study assessed the effect of paediatric Otrivine (0.05 per cent xylometazoline hydrochloride) on post-operative respiratory compromise.

Methods

Paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea were included. The control group (n = 24) received no intervention and the intervention group (n = 25) received intra-operative paediatric Otrivine during induction using a nasal patty. Post-operative outcomes included pain, respiratory distress signs and medical intervention level required (simple, intermediate and major).

Results

Post-operative respiratory distress signs were exhibited by 4 per cent of the Otrivine group and 21 per cent of the control group. Sixty-eight per cent of the Otrivine group required simple medical interventions post-operatively, compared to 42 per cent of the control group. In the Otrivine group, 4 per cent required intermediate interventions; none required major interventions. In the control group, 12.5 per cent required both intermediate and major interventions. Fifty per cent of the control group reported pain post-operatively, compared with 40 per cent in the Otrivine group.

Conclusion

Intra-operative paediatric Otrivine may reduce post-operative respiratory compromise in paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea. A randomised controlled trial is required.

Keywords

Sleep Apnea, ObstructiveSleep-Disordered BreathingDecongestants
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 2 , February 2019 , pp. 110 - 114
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Mr E Shamil takes responsibility for the integrity of the content of the paper

References

1Lumeng, JC, Chervin, RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 2008;5:242–52Google Scholar
2Marcus, CL, Brooks, LJ, Draper, KA, Gozal, D, Halbower, AC, Jones, J et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012;130:714–55Google Scholar
3Suen, JS, Arnold, JE, Brooks, LJ. Adenotonsillectomy for treatment of obstructive sleep apnea in children. Arch Otolaryngol Head Neck Surg 1995;121:525–30Google Scholar
4Lim, J, McKean, M. Adenotonsillectomy for obstructive sleep apnea in children. Cochrane Database Syst Rev 2003;(4):CD003136Google Scholar
5Richmond, KH, Wetmore, RF, Baranak, CC. Postoperative complications following tonsillectomy and adenoidectomy–who is at risk? Int J Pediatr Otorhinolaryngol 1987;13:117–24Google Scholar
6McColley, SA, April, MM, Carroll, JZ, Naclerio, RM, Loughlin, GM. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1992;118:940–3Google Scholar
7Wilson, K, Lakheeram, I, Morielli, A, Brouillette, R, Brown, K. Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology 2001;96:313–22Google Scholar
8Eskiizmir, G, Hirçin, Z, Ozyurt, B, Unlü, H. A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects. Eur J Clin Pharmacol 2011;67:19–23Google Scholar
9Chung, F, Liao, P, Yegneswaran, B, Shapiro, CM, Kang, W. Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology 2014;120:287–98Google Scholar
10Marcus, CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respir Physiol 2000;119:143–54Google Scholar
11De Luca Canto, G, Pachêco-Pereira, C, Aydinoz, S, Bhattacharjee, R, Tan, HL, Kheirandish-Gozal, L et al. Adenotonsillectomy complications: a meta-analysis. Pediatrics 2015;136:702–18Google Scholar
12Sanders, JC, King, MA, Mitchell, RB, Kelly, JP. Perioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome. Anesth Analg 2006;103:1115–21Google Scholar
13Clarenbach, CF, Kohler, M, Senn, O, Thurnheer, R, Bloch, KE. Does nasal decongestion improve obstructive sleep apnea? J Sleep Res 2008;17:444–9Google Scholar
14El-Seify, ZA, Khattab, AM, Shaaban, AA, Metwalli, OS, Hassan, HE, Ajjoub, LF. Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery. Br J Anaesth 2010;105:501–5Google Scholar
15McCluney, NA, Eng, CY, Lee, MS, McClymont, LG. A comparison of xylometazoline (Otrivine) and phenylephrine/lignocaine mixture (Cophenylcaine) for the purposes of rigid nasendoscopy: a prospective, double-blind, randomised trial. J Laryngol Otol 2009;123:626–30Google Scholar