The performance of a post-induction fentanyl-test in predicting postoperative respiratory adverse events in children after adenotonsillectomy.

Study objectives: Postoperative respiratory adverse events (PRAE) occurred more frequently in children having adenotonsillectomy than the general surgical population, and can require escalation of care. This study aims to assess the usefulness of postinduction fentanyl-test to predict PRAE in children with obstructive sleep apnea after adenotonsillectomy.

Methods: Two hundred and forty patients with obstructive sleep apnea undergoing adenotonsillectomy were included in this study. The oxygen saturation during sleep was monitored the night before adenotonsillectomy. Fentanyl-test was conducted under spontaneous breath after anesthesia induction with sevoflurane. Fentanyl-induced reduction in respiratory rate (FRR) was defined as the percentage of reduction in respiratory rate after 1 mcg/kg fentanyl administration. PRAE in the postanesthesia care unit included both respiratory complications and medical interventions. Receiver operating characteristic analysis was used to assess the usefulness of fentanyl-test in predicting PRAE.

Results: Of the 240 children undergoing elective adenotonsillectomy, 38 children (16%) experienced PRAE in postanesthesia care unit. The areas under receiver operating characteristic curve for FRR and nadir pulse oxygen saturation were 0.756 and 0.692, respectively. FRR greater than 53% best predicted PRAE in postanesthesia care unit, with a sensitivity of 68% and a specificity of 72%. Patients with FRR > 53% exhibited a significantly longer duration of desaturation requiring supplementary oxygen than those with FRR ≦ 53% (P < .001).

Conclusions: We suggest that postinduction fentanyl-test is a feasible evaluation for children undergoing adenotonsillectomy to predict early PRAE, especially for those who have not undergone polysomnography.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Effects of Individualized Opioid Analgesia Versus Conventional Opioid Analgesia After Adenotonsillectomy in Children; URL: https://clinicaltrials.gov/study/NCT04527393; Identifier: NCT04527393.

Citation: Liu H-E, He L. The performance of a post-induction fentanyl-test in predicting postoperative respiratory adverse events in children after adenotonsillectomy. J Clin Sleep Med. 2024;20(11):1749-1754.