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Comparison between the use of sevoflurane associated with propofol and sevoflurane alone for the anesthetic induction of DISE
The drug induced sleep endoscopy (DISE) has been proposed for a better evaluation of obstruction levels of the upper airway, as a therapeutic predictor, including OSA children, in which adenotonsillectomy, despite being considered the gold standard treatment, fails in about 30% of cases.
To compare the feasibility and safety of two anesthetic induction protocols for DISE in OSA children, propofol and sevoflurane versus sevoflurane alone.
95 OSA children submitted to DISE were enrolled. The children were divided into two groups, Group 1 received anesthetic induction by sevoflurane and propofol and Group 2 received only sevoflurane. The groups were compared regarding the need to interrupt the exam, frequency of hypersecretion, laryngospasm or bronchospasm and loss of anesthetic plan.
Group 1 consisted of 38 children, 8 girls, with a mean age 7.5 years; 6 (15.8%) had some complications and discontinued the exam. In 3 patients (7.9%) there was hypersecretion, making it impossible to visualize the structures, in 2 patients (5.3%) suffered laryngospasm with consequent desaturation of oxyhemoglobin, in 1 (2.7%) bronchoaspiration. Group 2 consisted of 57 children, 33 girls, with a mean age of 6.8 years. Only 1 patient (1.7%) interrupted the exam due to complete collapse of the upper airway structures, and it was not possible to assess the sites and obstruction.
DISE in children is not without risk and must be performed with an anesthesiologist in a safe environment, although the overall complication rate was low. The protocol with sevoflurane alone has proved to be safer and with less respiratory complications, being adopted as the current protocol for the exam at our hospital.
OSA, Child drug induced sleep endoscopy, anesthesia
Unesp Botucatu - São Paulo - Brasil
Vanessa Carvalho Lago, Vanessa Carvalho Lago, Antônio Carlos Marão, Jefferson Luís Barros, Karina Araujo Santos, Alexandre Palato Braga, Roberto Hugo Aguiar Abílio, Silke Anna Theresa Webber