Otolaryngologic clinics of North America
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Anesthesia for endoscopic assessment and treatment of airway problems in infants and children requires a systematic and thoughtful approach. The anesthesiologist and otolaryngologist should have a sound knowledge of the causes of airway obstruction. The anesthesiologist must be aware of the instrumentation likely to be used and the endoscopist must be well informed about the principles of anesthesia. The choice of technique depends upon the needs for each patient, but in most cases, the safest and most controlled method is a gaseous induction with assisted spontaneous respiration and continued maintenance by the inhalational method, supplemented by topically applied local anesthesia.
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Pediatric obstructive sleep apnea occurs in about 2% of children, and manifests as snoring, difficulty breathing, and witnessed apneic spells. Daytime symptoms include excessive sleepiness with poor performance and behavior problems. Severe forms may be associated with failure-to-thrive or death. ⋯ While most pediatric patients with obstructive sleep apnea can be treated with tonsillectomy and adenoidectomy; uvulopalatopharyngoplasty, tracheotomy, or other procedures are sometimes indicated. Nonsurgical treatment with continuous positive airway pressure is used in some children. Postoperative management in high-risk children includes careful perioperative monitoring and postoperative polysomnography.