2025 Volume 128 Issue 5 Pages 743-752
When surgery is performed under general anesthesia in adult patients with obstructive sleep apnea (OSA), the risks include difficulty in securing the airway after induction of general anesthesia, postoperative pharyngeal obstruction, and REM rebound. In particular, tonsillectomy under general anesthesia in adult patients with OSA is associated with the potential for further upper airway obstruction due to wound and airway edema and difficulty in endotracheal intubation due to postoperative bleeding. Therefore, when considering tonsillectomy under general anesthesia in patients with severe OSA and severe obesity who are expected to have severe upper airway narrowing, tracheostomy has been used as a prophylactic measure for safe and reliable securing of the airway. In this study, we reviewed the characteristics of 77 adult patients who underwent tonsillectomy under general anesthesia for OSA at the Department of Otolaryngology, Aichi Medical University, over the past 10 years and examined whether the risk of postoperative bleeding could be retrospectively predicted from the analysed factors.
Significant differences were found between the tracheostomy and non-tracheostomy groups in the body mass index, severity of OSA, sleep architecture, severity of hypoxemia during sleep, frequency of postoperative bleeding and hemostasis, prevalence of a low soft palate, prevalence of enlarged palatine tonsils, intubation difficulty, prevalence of upper airway stenosis, and use of indirect laryngoscopy during intubation and the BMI were identified as factors predictive of postoperative bleeding and hemostasis. In addition, the cutoff values of the BMI for predicting airway compromise and considering tracheostomy were investigated.
Prevention of postoperative airway obstruction after palatoglossal tonsillectomy in adult patients with OSA is discussed.
