Risk Factors for Postoperative Hypoxemia in Pediatric OSAHS Patients Undergoing Adenotonsillectomy: A Retrospective Study

Baclground : This study aimed to identify risk factors for perioperative respiratory adverse events in children with obstructive sleep apnea hypopnea syndrome (OSAHS) undergoing tonsillectomy under general anesthesia without supplemental oxygen in the post-anesthesia care unit (PACU), in order to provide clinical practice and improve management strategies. Methods A retrospective analysis was conducted on OSAHS pediatric patients admitted to the PACU without oxygen supplementation after surgery at our hospital between February and June 2023. Patients were categorized into hypoxemia and non-hypoxemia groups based on their PACU oxygen saturation levels. Binary logistic regression analysis was employed to identify independent risk factors for hypoxemia. Results A total of 660 pediatric patients were reviewed, of which 631 met the inclusion criteria. Among these, 146 children (23.1%) developed hypoxemia in the PACU. Preoperative abnormalities on chest X-ray findings (such as increased and blurred lung markings) and the COVID-19 Anit-IgG in blood tests showed statistically significant differences between the hypoxemia and non-hypoxemia groups. The sufentanil dose used intraoperatively was significantly higher in the hypoxemia group compared to the non-hypoxemia group (2.9 ± 1.4 µg vs. 2.5 ± 1.2 µg, P < 0.001). Notably, children who had a cough within one week prior to surgery were higher risk of developing hypoxemia in the PACU (61.6% vs. 16.0%). Among these patients, 28.3% required a chin lift, 7.1% required an oropharyngeal airway, and 5.1% needed bag-mask ventilation. Binary logistic regression analysis identified abnormal chest X-ray findings, recent preoperative cough, COVID-19 Anti-IgG positive, and higher intraoperative sufentanil dosage as independent risk factors for hypoxemia in the PACU. Conclusions Postoperative hypoxemia in pediatric OSAHS patients is significantly associated with preoperative cough, abnormal chest X-ray, and sufentanil dosage. Enhanced perioperative monitoring and tailored management strategies are recommended for high-risk patients.