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13.05.2022 | Sleep Breathing Physiology and Disorders • Original Article

Perioperative outcomes and the effects of anesthesia in congenital central hypoventilation patients

verfasst von: Gloria Y. Chang, Tate Salazar, Abhishek Karnwal, Sheila S. Kun, Josephine Ellashek, Cathy E. Shin, J. Gordon McComb, Thomas G. Keens, Iris A. Perez

Erschienen in: Sleep and Breathing | Ausgabe 2/2023

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Abstract

Purpose

Patients with congenital central hypoventilation syndrome (CCHS) have autonomic dysfunction and lack ventilatory responses to hypoxemia and hypercarbia and thus are prone to adverse events during general anesthesia. The objective of this study was to describe the perioperative outcomes of patients with CCHS who were undergoing diaphragm pacer (DP) implantation surgeries under general anesthesia.

Methods

A retrospective cohort study was conducted on patients with CCHS who underwent DP implantation surgeries at CHLA between January 2000 and May 2016. Charts were reviewed for demographics, PHOX2B genotype, ventilatory support, comorbidities, anesthesia administered, and perioperative courses.

Results

Of 19 patients with CCHS (58% female) mean age at surgeries was 8.6 ± 5.8 years. Seventeen patients were ventilator-dependent during sleep only; two were ventilator dependent 24 h per day. Mean surgery duration was 3.1 ± 0.5 h. Seventeen patients were extubated to PPV via tracheostomy in the OR. Two patients were extubated to NPPV on postoperative day (POD) 1. Mean transition time to home ventilator or NPPV was 3.0 ± 2.2 days, and mean hospital stay was 5.0 ± 2.1 days. One patient premedicated without ventilatory support developed hypoxemia and hypoventilation. Ten patients (52%) had intraoperative events such as bradycardia, hypotension, significant hypoxemia, and bronchospasm. Fifteen patients had postoperative events. Hypoxemia, pneumonia, and atelectasis accounted for most of perioperative complications. One patient experienced seizure on POD 2 due to hypercarbia.

Conclusion

Patients with CCHS are vulnerable to the cardiorespiratory effects of sedative and anesthetic agents. Therefore, they require vigilant monitoring and optimal ventilatory support in the perioperative period.

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Titel: Perioperative outcomes and the effects of anesthesia in congenital central hypoventilation patients
verfasst von: Gloria Y. Chang
Tate Salazar
Abhishek Karnwal
Sheila S. Kun
Josephine Ellashek
Cathy E. Shin
J. Gordon McComb
Thomas G. Keens
Iris A. Perez
Publikationsdatum: 13.05.2022
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 2/2023
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-022-02632-z

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Perioperative outcomes and the effects of anesthesia in congenital central hypoventilation patients