• Anthony Cultrara, Garrett H Bennett, Craig Lazar, Joseph Bernstein, and Nira Goldstein.
• Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203-2098, USA. cultrata@yahoo.com
• Int. J. Pediatr. Otorhinolaryngol. 2002 Dec 2; 66 (3): 243-6.

ObjectiveBased on a few reports that describe obstructive sleep apnea (OSA) patients as having an increased risk of acute upper airway obstruction (UAO) after pharmacological sedation, this population is less likely to receive sedation prior to surgery. Our objective was to evaluate pediatric patients with sleep-disordered breathing who received preoperative sedation to determine if there was an increase in preoperative airway obstruction.DesignRetrospective chart review from 1995 to 2000.SettingTwo tertiary care academic medical centers.PatientsSixty-five children (mean age=4.7+/-2.3 years; 49 boys, 16 girls) diagnosed with sleep-disordered breathing by sleep study or clinical evaluation that received preoperative midazolam hydrochloride.Outcome MeasureThe occurrence of preoperative adverse events defined as UAO, hypoventilation, desaturation, bradycardia, or sustained lethargy that required active intervention after the administration of midazolam hydrochloride within 24 h of surgery.ResultsNone of the 65 children evaluated in this study experienced respiratory compromise requiring intervention after the administration of preoperative sedation. Potential risk factors such as patients' age, sex, weight, comorbidities, midazolam hydrochloride dose, and severity of sleep apnea did not appear to affect outcome.ConclusionThe preliminary data suggested that preoperative sedation might be safely administered to children with mild or moderate sleep-disordered breathing, and possibly to children with severe OSA, if children are closely observed prior to surgery. Further prospective studies are needed to confirm these results.

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