Pharmacologic Manipulation of Emergence after Adenotonsillectomy for Pediatric Obstructive Sleep Apnea: A Prospective Controlled Study

Objectives: 1) Elucidate the factors affecting emergence from anesthesia after adenotonsillectomy for obstructive sleep apnea (OSA) in children. 2) Highlight the advantages of a standardized anesthetic protocol in controlling peri-operative events. Methods: A non-randomized, prospective, observational study (n = 64) was designed to examine the relationship between the severity of OSA, as determined by apnea-hypopnea index (AHI) and oxygen saturation (SpO2) nadir, and indices of recovery, including time to 1) emergence after surgery, 2) extubation following emergence, and 3) discharge from the post-anesthesia care unit. A standardized anesthetic protocol was used in all patients using doses of opioids that inversely correlated with OSA severity. Results: A paradoxical yet significant reduction in recovery time was observed among patients with severe OSA following surgery; this reflected in quicker emergence, accelerated extubation, and shortened postanesthesia care unit discharge times (analysis of variance, Tukey-Kramer post-hoc tests, P < 0.001) besides a reduction in adverse events. In addition, the relationship between polysomnography (PSG)-derived AHI and SpO2 nadir varied inversely with each of the recovery indices, as determined by a linear regression analysis (t-tests, P