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Brown KA 《Paediatric anaesthesia》2011,21(7):771-780
Adenotonsillectomy is the mainstay of treatment for pediatric obstructive sleep apnea syndrome (OSAS). However, there is evidence that the child with severe OSAS is at increased risk of respiratory compromise. The most difficult risk factor to assess is the severity of OSAS, and these difficulties are reviewed. 相似文献
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BACKGROUND: Optimal analgesia for children undergoing adenotonsillectomy for obstructive sleep apnea (OSA) is controversial. Tramadol may represent a superior choice over morphine in this group, with a potential to cause less postoperative sedation and respiratory depression. Optimal perioperative analgesia may allow expensive and time-consuming preoperative work-up and postoperative monitoring to be rationalized. METHODS: Sixty-six children were randomized to receive either perioperative tramadol or morphine in this double blinded, prospective, controlled trial. Postoperative sedation, pain, respiratory events, and vomiting were then compared between groups. RESULTS: There was no significant difference between the two groups in sedation scores 1 h after arrival in recovery (P = 0.24) or at any other time up to 6 h postoperation. There was also no evidence of a difference between the groups in pain scores up to 6 h postoperation. There were fewer episodes of postoperative desaturation (<94%) in the tramadol group up to 3 h postoperation, with 26% fewer episodes in the tramadol group during the second hour postoperation (P = 0.02). Overall, there was a trend toward fewer desaturation episodes in the tramadol group. CONCLUSIONS: Tramadol may be a suitable drug for children undergoing adenotonsillectomy for OSA. Further work is required to investigate this. 相似文献
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Obstructive sleep apnea (OSA) is frequently associated with obesity and metabolic syndrome. Also frequently associated with metabolic syndrome is type 2 diabetes mellitus (T2DM). Therefore, it is common to find OSA and T2DM together in individuals with metabolic syndrome. Additionally, both OSA and T2DM have a common pathophysiological link with development of insulin resistance. Individuals with severe insulin resistance are likely to have inadequate glycemic control. Long standing poorly controlled T2DM is associated with debilitating microvascular complications such as retinopathy, nephropathy, neuropathy and macrovascular complications such as coronary artery and cerebrovascular disease. There is extensively published literature exploring the cause-effect relationship between OSA and T2DM. In this article we provide an in-depth review of the complex pathophysiological mechanisms linking OSA to T2DM. Specifically, this review focusses on the effect of OSA on the microvascular complications of T2DM such as retinopathy, nephropathy and neuropathy. Additionally, we review the current literature on the effect of continuous positive airway pressure use in individuals with T2DM and OSA. 相似文献
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Sheri Jones Oguh Lisa Elden Jordan Swanson Ignacio Tapia Rajeev Subramanyam 《Paediatric anaesthesia》2020,30(3):232-240
Obstructive sleep apnea (OSA) has a prevalence of up to 5% in children and 50% in obese children. OSA is associated with various comorbidities in the general population and in the perioperative period. In this review, we will provide background of OSA and insights into the available treatment options both surgically and medically. Unlike adults, most pediatric OSA is treated with adenotonsillectomy. Continuous positive airway pressure therapy is the commonly used medical treatment. Management of pediatric OSA is multidisciplinary. We will discuss the surgical options and medical options of managing pediatric OSA. 相似文献
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Obstructive sleep apnea is a common childhood disorder which can lead to serious health problems if left untreated. Enlarged adenoid and tonsils are the commonest causes, and adenotonsillectomy is the recommended first line of treatment. Obstructive sleep apnea poses as an anesthetic challenge, and it is a well‐known risk factor for perioperative adverse events. The presence and severity of an obstructive sleep apnea diagnosis will influence anesthesia, pain management, and level of monitoring in recovery period. Preoperative obstructive sleep apnea assessment is necessary, and anesthetists are ideally placed to do so. Currently, there is no standardized approach to the best method of preoperative screening for obstructive sleep apnea. Focused history, clinical assessments, and knowledge regarding the strengths and limitations of available obstructive sleep apnea assessment tools will help recognize a child with obstructive sleep apnea in the preoperative setting. 相似文献
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Norman Bolden MD Assistant Professor Charles E. Smith MD FRCPC Professor Dennis Auckley MD Associate Professor 《Journal of clinical anesthesia》2009,21(4):286-293
Obstructive sleep apnea (OSA) is associated with postoperative airway obstruction, hypoxemia, cardiac arrhythmias, cardiorespiratory arrest, hypoxic encephalopathy, and death. Three cases highlighting important issues in patients with OSA are presented that occurred prior to and after implementation of an OSA protocol. 相似文献
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阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome, OSAS)是常见的临床疾病之一,患病率高,具有潜在致死性,严重威胁到人类健康。骨质疏松症(osteoporosis, OP)被称为静悄悄的杀手,是一种严重危害骨骼健康的慢性疾病。随着我国老龄化进程加速,我国OP患病人数已位于全球第一。《健康中国2030》倡导及早筛查OP,其与OSAS及其合并症的发生发展密切相关。笔者就OSAS与OP的相关研究展开综述,为临床后续深入研究提供依据。 相似文献
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Essam F. Abdelgalel 《Egyptian Journal of Anaesthesia》2018,34(4):151-157
Background
The aim of this study was to evaluate if the addition of dexmedetomidine to propofol could improve the success and reduce the complications during drug induced sleep endoscopy in obstructive sleep apnea patients.Patient and methods
Fifty adult patients scheduled for drug induced sleep endoscopy were randomly allocated to one of two groups. Group P (25 patients) received propofol loading dose of 0.5?mg/kg over 3?min then continuous infusion in a dose of 25–75?mcg/kg/min. Group PD (25 patients) received propofol infusion as group P and dexmedetomidine intravenous infusion with a loading dose of 0.5?mcg/kg over 5?min then continuous infusion in a dose of 0.2–0.7?mcg/kg/h. The primary outcome was successful completion of the procedure. The secondary outcomes included the time to start endoscopy, procedure duration, the incidence of adverse events and surgeons and patients satisfaction.Results
Successful completion of the procedure was significantly higher in group PD (96%) compared to group P (72%). The total propofol dose needed/patient (mg) was significantly more in group P compared to group PD (173.5?±?41.6 versus98.4?±?19.8 with shorter recovery time in group PD. Both surgeons and patients satisfaction were significantly higher in group PD compared to group P. The incidence of cough and gag reflexes were significantly higher in group P compared to group PD. Heart rate (HR) was significantly lower in group PD compared to group P at 5, 10, 15, 20, 25 and 30?min from the start of the studied drugs. Respiratory rate (RR) was significantly lower in group P compared to group PD at 5, 10, 15 and 20?min from the start of the studied drugs (p?<?0.05).Conclusion
Addition of dexmedetomidine to propofol is associated with higher incidence of successful completion of the procedure with faster recovery. Cough and gag reflexes were significantly lower with the addition of dexmedetomidine with higher surgeons and patients satisfaction. 相似文献13.
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Critical evaluation of the overactive bladder and urgency urinary incontinence association with obstructive sleep apnea syndrome in a relatively young adult male population 下载免费PDF全文
Murat Tuncer Ozgur Yazici Alper Kafkasli Kubilay Sabuncu Banu Salepci Fehmi Narter Gulten A. Gungor Ugur Yucetas 《Neurourology and urodynamics》2017,36(7):1804-1808
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目的 探讨男性阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者骨密度改变以及与氧化应激、性激素水平变化的相关性.方法 通过多导睡眠(polysomnography,PSG)监测入选48例男性OSAHS患者,其中轻中度组19例,重度组29... 相似文献
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Perimenis P Karkoulias K Konstantinopoulos A Perimeni PP Katsenis G Athanasopoulos A Spyropoulos K 《Asian journal of andrology》2007,9(2):259-264
Aim: To assess the efficacy of sildenafil and continuous positive airway pressure (CPAP) in the treatment of concurrent erectile dysfunction (ED) with obstructive sleep apnea (OSA), and to gauge the level of treatment satisfaction in patients and their partners. Methods: Forty men were treated for 12 weeks with sildenafil 100 mg (20 men) or CPAP during nighttime sleep (20 men). Treatment efficacy was assessed by the rate of successful intercourse attempts, and satisfaction with treatment was assessed by patients' and partners' answers to question 1 of the Erectile Dysfunction Inventory of Treatment Satisfaction. Results: Under sildenafil, 128 of 249 (51.4%) intercourse attempts were successful; under CPAP, 51 of 193 (26.9%) attempts were successful (^cp 〈 0.001). Erectile function was improved in both groups. After sildenafil and CPAP treatment, the mean International Index for Erectile Function domain scores were 14.3 and 10.8, respectively (^bp = 0.025), compared to 7.8 and 7 at baseline, respectively. CPAP and sildenafil were well tolerated. Sporadic episodes of nasal dryness under CPAP and transient headache and flushing under sildenafil were not significant. Fifty percent of patients treated with sildenafil and 25% with CPAP were satisfied with the treatment, and their partners were equally satisfied. The satisfaction scores for both patients and partners under sildenafil were superior to those under CPAP (^cP 〈 0.002). Conclusion: Both sildenafil 100 mg and CPAP, used separately, had positive therapeutic impact but sildenafil was superior. Patients and their partners were more satisfied with sildenafil for the treatment of ED. However, because of the high proportion of dissatisfied men and partners, new therapeutic agents or a combination of the two methods must be studied further. 相似文献
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目的:评价持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停综合征(OSAS)患者勃起功能障碍(ED)的影响。方法:计算机检索Cochrane Library、PubMed、中国学术期刊全文数据库、中国生物医学文献数据库、万方资源数据库和中国重要会议论文全文数据库并手工检索相关期刊,全面收集CPAP对OSAS合并性功能障碍的临床研究,按照纳入、排除标准选择实验研究并评价质量,而后提取有效数据进行meta分析。结果:最终纳入4篇文献,1篇中文,3篇英文,包括77例患者。meta分析结果显示各研究间无统计学异质性(P=0.80;I2=0%),故采用固定效应模型进行meta分析。结果显示经CPAP治疗后,IIEF-5增高[WMD=4.19,95%(3.01,5.36),P<0.001]。结论:现有临床研究证据显示,对于OSAS合并ED患者,CPAP治疗能明显减轻ED。但因研究质量及研究样本存在明显局限性,期待更多高质量、大规模的临床随机对照研究加以验证。 相似文献
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Combined transoral robotic tongue base surgery and palate surgery in obstructive sleep apnea‐hypopnea syndrome: Expansion sphincter pharyngoplasty versus uvulopalatopharyngoplasty 下载免费PDF全文
Claudio Vicini MD Filippo Montevecchi MD Kenny Pang MD Ahmed Bahgat MD Iacopo Dallan MD Sabrina Frassineti MD Aldo Campanini MD 《Head & neck》2014,36(1):77-83
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Jason Silvestre Youssef Tahiri J Thomas Paliga Jesse A Taylor 《CANADIAN JOURNAL OF PLASTIC SURGERY》2014,22(4):259-263