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Literature Review: A Roundup of Important Recent Studies

Routine ICU Admission for All Post-Surgical OSA Patients Unnecessary

Do patients undergoing multi-level airway surgery for obstructive sleep apnea (OSA) require routine intensive care unit admission after surgery?

Background: Patients undergoing surgery for OSA have been identified as high risk for post-operative complications. However, there is no standard with regard to the type of monitoring required after surgery, which ranges from discharging the patient home after recovery room observation to overnight intensive care monitoring.

Study design: Retrospective review of consecutive patients.

Setting: Tertiary care hospital, Singapore.

Synopsis: The records of 487 consecutive adult patients undergoing nasal and palatal surgery with (NPT) and without (NP) tongue base surgery for OSA were reviewed for complications. Those undergoing NP were monitored for six hours after surgery and discharged, while those undergoing NPT were monitored in a step-down unit overnight. In total, 7 percent of patients had complications, including oxygen desaturation (1.2 percent), persistent hypertension (3.1 percent), postobstructive pulmonary edema (0.4 percent), tongue swelling (1.8 percent), airway obstruction (0.2 percent) and bleeding (3.1 percent). All desaturations occurred within 180 minutes after surgery. All of the tongue swelling and airway obstruction complications were secondary to tongue suspension suture placement.

While the authors acknowledge that narcotics make post-operative respiratory complications more likely, they do not document how pain was managed in these patients. They also make a number of suggestions for post-operative care but include no analysis supporting these findings. Finally, they suggest close post-operative monitoring for three hours in the recovery room to determine whether admission to a surgical floor or increased monitoring environment is necessary.

Bottom line: Patients with post-operative desaturations after undergoing multi-level airway surgery for OSA had them within three hours of the surgery and may not require admission if undergoing nasal and palatal surgery alone. Those undergoing tongue procedures and suspension suture placement in particular had an increased likelihood of complications.

Reference: Pang KP, Siow JK, Tseng P. Safety of multilevel surgery in obstructive sleep apnea: a review of 487 cases. Arch Otolaryngol Head Neck Surg. 2012;138(4):353-357.

—Reviewed by Stacey L. Ishman, MD

Parent Education for Adenotonsillectomy Risks

Do parents understand more of the risks of adenotonsillectomy when pre-operative teaching utilizes standard counseling and a handout versus a video?

Background: Adenotonsillectomy is one of the most commonly performed surgical procedures in children, and yet parental understanding of the procedure’s risks is often limited. In addition, little is known about the optimal way to provide patient and parental education.