Perioperative respiratory complications following awake and deep extubation in children undergoing adenotonsillectomy

Background: Perioperative respiratory complications after adenotonsillectomy (T&A) are common and have been described to occur more frequently in children below 3years of age, those with cranio-facial abnormalities, Down syndrome, obstructive sleep apnea, morbid obesity, and failure to thrive. Aims: To investigate the association between awake vs deep tracheal extubation and perioperative respiratory conditions. Results: The primary outcome was any perioperative respiratory complication. Major complications included the need for airway reinstrumentation, continuous or bi-level positive airway pressure (CPAP or BiPAP) and ventilation, or pharmacologic intervention for managing airway obstruction. Minor respiratory complications included persistent hypoxemia defined as oxygen saturation (SpO(2)) <92% for 30s or postoperative oxygen dependence for hypoxemia for 15min. There was no statistically significant difference in the incidence of any perioperative respiratory complication in children undergoing an awake vs deep extubation (18.5% and 18.9% for awake and deep extubation, respectively (P=0.93)). Only low weight (14kg) was associated with increased perioperative respiratory complications (P=0.005). In this study, factors found not to be statistically significant with perioperative respiratory complications included age; presence of Down syndrome, cranio-facial abnormality, or cerebral palsy; obstructive sleep apnea confirmed by polysomnography; diagnosis of obstructive sleep apnea by clinical history; presence of an upper respiratory tract infection (URI) within 2weeks of presentation; history of reactive airway disease; status at extubation; endtidal sevoflurane and carbon dioxide concentrations at extubation; total intraoperative opioids administered in morphine equivalents (mgkg(-1)); administration of propofol at extubation; and intraoperative administration of an anticholinergic drug. Conclusions: There was no difference in the incidence of perioperative respiratory complications in children undergoing a T&A following an awake vs deep extubation. Only weight 14kg was associated with increased perioperative respiratory complications.