The use of medical treatment to optimize respiratory function prior to adenotonsillectomy for sleep disordered breathing in the children under 3 years old

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Helen Caulfield

Nose and Ear Hospital, UK

: J Otol Rhinol

Abstract

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Pediatric sleep disordered breathing encompasses a spectrum ranging from simple snoring to obstructive sleep apnoea syndrome. Adenotonsillectomy represents an effective treatment for sleep disordered breathing, but the literature reveals that children under 3 years are at greater risk of having more severe obstructive sleep apnoea syndrome and higher rates of postoperative respiratory adverse events. Suddenly relieving the hypercarbia present in some sleep disordered breathing patients by removing the upper airway obstruction can result in pulmonary oedema and acute respiratory failure. The ENT-UK multidisciplinary working party consensus statement (2008) included children under 2 years (or under 15 kg) with sleep disordered breathing in the at risk group. It was recommended that these children should be recovered in intensive care unit facilities. It was noted that there is currently a lack of evidence for adverse respiratory outcomes in this country with no published case series. We present how we manage the under-3 year age group undergoing adentonsillectomy for sleep disordered breathing in a unit without a pediatric intensive care unit.

Biography

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Helen Caulfield is graduated from University College Hospital (UCH) School of Medicine, London, UK in 1987. She showed an early commitment to pursue a surgical career, obtained a highly prestigious professorial unit House Officer’s job as her first post at UCH. She completed training in Neurosurgery at Kings College and General Surgery at Charing Cross Hospital, London. Subsequently, she developed a broad-based ENT training rotating through St. Bartholomew’s Hospital and the North Thames Sector Hospitals, including the prestigious Royal National Throat Nose and Ear Hospital in London and the Radcliffe Infirmary in Oxford. She pursued further training as a Specialist Pediatric ENT Surgeon, by spending two years in Sydney Australia, under the guidance of Bruce Benjamin, a world famous Pediatric Laryngologist. She was a Fellow at New Children’s Hospital in Sydney during this period. On her return to London in 1999, she took up a post at Great Ormond Street Hospital, and remained there for a 12 month period, prior to obtaining her consultant’s post. In 2000, she was appointed as ENT Consultant at the Royal Free Hospital and Honorary Senior Lecturer at the Royal Free Medical School.