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S1-Leitlinie: Obstruktive Schlafapnoe im Rahmen von Tonsillenchirurgie mit oder ohne Adenotomie bei Kindern – perioperatives Management

German S1 guideline: obstructive sleep apnea in the context of tonsil surgery with or without adenoidectomy in children—perioperative management

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Zusammenfassung

Operationen aus dem Fachgebiet der Hals-Nasen-Ohren-Heilkunde zählen zu den häufigsten operativen Eingriffen im Kindesalter. Die Tonsillenchirurgie mit oder ohne Adenotomie aufgrund einer adenotonsillären Hyperplasie mit Obstruktion der oberen Atemwege in Kombination mit oder ohne Belüftungsstörung des Mittelohrs ist bei diesen Eingriffen führend. Kinder mit obstruktiver Schlafapnoe (OSA) haben hierbei ein deutlich erhöhtes Risiko, perioperativ respiratorische Komplikationen zu erleiden. Es wurde über Todesfälle und bleibende neurologische Schäden aufgrund von Apnoe und einer erhöhten Opioidsensibilität berichtet. Die vorliegende Leitlinie stellt einen risikoadjustierten pragmatischen Ansatz dar. Patienten mit bestätigter oder vermuteter OSA sollen perioperativ entsprechend ihren individuellen Risiken und Bedürfnissen behandelt und überwacht werden, um schwere bleibende Schäden zu verhindern.

Abstract

Otolaryngologic surgery is one of the most frequent operative interventions performed in children. Tonsil surgery with or without adenoidectomy due to hyperplasia of the tonsils and adenoids with obstruction of the upper airways with or without tympanic ventilation disorder is the most common of these procedures. Children with a history of sleep apnoea (OSA) suffer from a significantly increased risk of perioperative respiratory complications. Cases of death and severe permanent neurologic damage have been reported due to apnoea and increased opioid sensitivity. The current guideline represents a pragmatic risk-adjusted approach. Patients with confirmed or suspected OSA should be treated perioperatively according to their individual risks and requirements, in order to avoid severe permanent damage.

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Abb. 1

Notes

  1. siehe Liste am Beitragsende

  2. Um die Differenzierung zwischen Tonsillektomie und Tonsillotomie im Text klar darzustellen, werden die semantischen Unterschiede durch Kursivierung hervorgehoben.

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Autoren, die an der Erstellung der Leitlinie mitgewirkt haben

Dr. med. Gregor Badelt Klinik für Anästhesie und Kinderanästhesie Krankenhaus Barmherzige Brüder Regensburg Klinik St. Hedwig Steinmetzstraße 1–3 D‑93049 Regensburg

Dr. med. Karin Becke-Jakob Abteilung für Anästhesie und Intensivmedizin Klinik Hallerwiese/Cnopf’sche Kinderklinik Diakonie Neuendettelsau St. Johannis-Mühlgasse 19 90419 Nürnberg

Prof. Dr. med. Thomas Deitmer Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. Friedrich-Wilhelm-Str. 2 53113 Bonn

Prof. Dr. med. Christoph Eich Abteilung Anästhesie, Kinderintensiv- und Notfallmedizin Kinder- und Jugendkrankenhaus AUF DER BULT Janusz-Korczak-Allee 12 30173 Hannover

PD Dr. med. Christiane Goeters Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie Universitätsklinikum Münster Albert-Schweitzer-Campus 1, Gebäude A1 48149 Münster

Prof. Dr. med. Claudia Höhne Klinik für Anästhesie, Schmerztherapie, Intensiv- und Notfallmedizin DRK Kliniken Berlin I Köpenick Salvador-Allende-Straße 2–8 12559 Berlin

Prof. Dr. med. Boris A. Stuck Klinik für Hals‑, Nasen- und Ohrenheilkunde Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg Baldingerstraße 35043 Marburg

Dr. med. Alfred Wiater Kinder- und Jugendarzt/Schlafmedizin Große Neugasse 6 50667 Köln

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Authors and Affiliations

  1. Klinik für Anästhesie und Kinderanästhesie, Krankenhaus Barmherzige Brüder Regensburg, Klinik St. Hedwig, Steinmetzstraße 1–3, 93049, Regensburg, Deutschland

    G. Badelt

  2. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI) | Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Nürnberg, Deutschland

    G. Badelt,  C. Goeters,  K. Becke-Jakob,  C. Eich &  C. Höhne

  3. Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. (DGHNO KHC), Friedrich-Wilhelm-Str. 2, 53113, Bonn, Deutschland

    T. Deitmer &  B. A. Stuck

  4. Kinder- und Jugendmedizin/Schlafmedizin, Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) | Arbeitsgruppe Pädiatrie im Konvent der Deutschen Gesllschaft für Kinder- und Jugendmedizin, Schwalmstadt-Treysa, Deutschland

    A. Wiater

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Correspondence to G. Badelt.

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Alle Mitglieder haben Erklärungen zu möglichen Interessenkonflikten abgegeben. Diese wurden im Rahmen der Leitlinienkonferenz von den Autoren auf thematische und geringe, moderate, hohe Relevanz geprüft und konsentiert. Relevante Interessenkonflikte, die eine Konsequenz erforderlich gemacht hätten, wurden nicht festgestellt.

Additional information

Erstveröffentlichung: Anästh Intensivmed 2020;61:587–597. https://doi.org/10.19224/ai2020.587

Dieser Beitrag erschien in der Zeitschrift HNO https://doi.org/10.1007/s00106-020-00970-6. Angenommen: 24. November2020

Der Abdruck erfolgt mit freundlicher Genehmigung der beteiligten Fachgesellschaften.

Copyright: Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V. (DGAI) | Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA).

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Kinderärztlicher Fragebogen: Sleep-Disordered Breathing Subscale Version 1.0 GERMAN PSQ-SRBD-Subscale-DE: Übersetzung Wiater/Sagheri 2009, Abklärungsalgorithmus Schnarchen im Kindesalter nach [1] (License Number 4590270232867)

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Badelt, G., Goeters, C., Becke-Jakob, K. et al. S1-Leitlinie: Obstruktive Schlafapnoe im Rahmen von Tonsillenchirurgie mit oder ohne Adenotomie bei Kindern – perioperatives Management. Somnologie 25, 54–64 (2021). https://doi.org/10.1007/s11818-021-00303-x

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