Management of postoperative respiratory complication in a child with severe obstructive sleep apnoea syndrome during Covid-19
More details
Hide details
Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Malaysia
Department of Otorhinolaryngology, Hospital Serdang
Jeyasakthy Saniasiaya   

Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, WP Kuala Lumpur, Malaysia. Tel.: +60126841223.
Submission date: 2021-10-16
Final revision date: 2022-10-01
Acceptance date: 2022-10-01
Online publication date: 2022-11-03
Pol. Ann. Med. 2022;29(2):233–237
Coronavirus disease (Covid-19) was first discovered in December 2019 with no signs of conceding to date. Many operations which are regarded as not lifesaving are postponed indefinitely owing to hospital bed shortage as well as to reduce the spread of infection among patients and staff. However, healthcare professionals are thrown down a huge challenge when deciding the timing of treatment for non-life-threatening conditions like severe paediatric obstructive sleep apnoea syndrome (OSAS) with a substantial impact on the development of very young children.

To outline management of postoperative respiratory complication in a child with severe obstructive sleep anoea syndrome during Covid-19.

Case study:
We present a case of a major respiratory event requiring reintubation that developed post-adenotonsillectomy in a 3-year-old child with severe OSAS.

Results and discussion:
The child was given close monitoring for 6 h in the post-anaesthetic care unit (PACU) before he was transferred to the general paediatric ward, without PICU admission during his stay in the hospital.

Postoperative monitoring at the step-down unit with a high nurse-to-patient ratio appears to be beneficial as it does not compromise the need for close postoperative observation, meanwhile saving costs.

We would like to thank all involved.
No funding involved.
All authors have no conflict of interest.
Bixler EO, Vgontzas AN, Lin HM, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009;32(6):731–736.
Li AM, So HK, Au CT, et al. Epidemiology of obstructive sleep apnoea syndrome in Chinese children: a two-phase community study. Thorax. 2010;65(11):991–997.
O’Brien LM, Holbrook CR, Mervis CB et al. Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/ hyperactivity disorder. Pediatrics. 2003;111(3):554–563.
Bogucki ZA, Jaworski A, Kowalczyk-Zając M, Dobrzyński M. Advances in diagnosis and treatment of obstructive sleep apnea. Pol Ann Med. 2018;25(1):162–165.
Marcus CL, Rosen G, Davidson Ward SL, et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics. 2006;117(3):442–451.
Dehlink E, Tan HL. Update on paediatric obstructive sleep apnoea. J Thorac Dis. 2016;8(2):224–235.
Nixon GM, Kermack AS, Davis GM, Manoukian JJ, Brown KA, Brouillette RT. Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. Pediatrics. 2004;113(1 Pt 1):19–25.
Kaditis AG, Alvarez MLA, Boudewyns A, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016;47(1):69–94.
Benedek P, Keserü F, Kiss G, et al. Postoperative respiratory complications in children with obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital. 2022;42(2):162–168.
Walker P, Whitehead B, Rowley M. Criteria for Elective Admission to the Paediatric Intensive Care Unit Following Adenotonsillectomy for Severe Obstructive Sleep Apnoea. Anaesth Intensive Care. 2004;32(1):43–46.
Wilson K, Lakheeram I, Morielli A, Brouillette R, Brown K. Can Assessment for Obstructive Sleep Apnea Help Predict Postadenotonsillectomy Respiratory Complications? Anesthesiology. 2002;96(2):313–322.
Roland PS, Rosenfeld RM, Brooks LJ, et al. Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children. Otolaryngol Head Neck Surg. 2011;145(1 Suppl):1–15.
McColley SA, April MM, Carroll JL, Naclerio RM, Loughlin GM. Respiratory Compromise After Adenotonsillectomy in Children with Obstructive Sleep Apnea. Arch Otolaryngol Head Neck Surg. 1992;118(9):940–943.
Arambula AM, Xie DX, Whigham AS. Respiratory events after adenotonsillectomy requiring escalated admission status in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2018;107:31–36.
Lokman FL, Goh BS. Paediatric Adenotonsillectomy: Its Safety and Outcome in a Malaysian Tertiary Medical Center. Indian J Otolaryngol Head Neck Surg. 2020:1–6.