Pediatric obstructive sleep apnea: anesthesiologic implications in patients undergoing otolaryngological surgery

Introduction: Pediatric obstructive sleep apnea syndrome (OSAS) represents a high anesthetic risk condition, particularly in children undergoing ENT procedures [1]. This study aims to assess the impact of OSAS on perioperative management under general anesthesia. Materials and Methods A single-center, prospective, observational study was conducted at the Department of Anesthesia and Intensive Care, in collaboration with the Department of Otolaryngology, at San Salvatore Civil Hospital in L’Aquila, between July 4, 2024, and December3, 2024. Pediatric patients (aged 3–16 years), classified as ASA I–II, undergoing adenoidectomy, tonsillectomy, or adenotonsillectomy were enrolled. Patients were divided into two groups: Group A with OSAS, Group B without OSAS. Anesthetic, intraoperative, and postoperative variables were analyzed using non-parametric statistical methods. Results: A total of 40 patients were included: 21 with OSAS (52.5%) and9 without OSAS (47.5%). The presence of OSAS was associated with significantly longer surgical duration (51.7 ±6.2 min vs 40.2 ±7.1 min; p=0.0248) (Table), lower oxygen saturation at T0 (97.5% vs 98.8%; p<0.001) and T1 (99.0% vs 99.9%; p<0.0001) (Tables 2 and 3), and a higher number of intubation attempts (66.67% vs 5.26%; p<0.0001) (Table 4). Additionally, OSAS patients showed prolonged Page 100 of 141 J Anesth Analg Crit Care 2025, 5(Suppl 1):58 awakening times (18.2 ± 4.2 min vs1.2 ±.9 min; p<0.0001) and longer stays in the post-anesthesia care unit (9.9 ± 2.4 min vs 7.6 ± 2.8 min; p=0.0103) (Table 5). Conclusions The results highlight that pediatric patients with OSAS are at higher anesthetic risk, requiring careful preoperative planning and tailored perioperative protocols. A multidisciplinary approach and extended postoperative monitoring are essential to minimize the risk of complications and ensure perioperative safety [2].