Friday, May 12, 2017
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This protocol was last updated before 2017

Overview

The current guidelines for management of pediatric obstructive sleep apnea recommend adenotonsillectomy first; this has a >80% success rate (AAOHNS position statement, Tonsillectomy and OSAs, adopted 2010 revised 2014). Sleep endoscopy prior to surgical intervention for sleep apnea to identify the level of obstruction is now gaining traction though it is difficult to link this relatively noninvasive procedure to improved outcomes yet (Manickam et al 2016).

For sleep endoscopies during which the patient will be mask ventilated during flexible fiberoptic exam through the mask, you will need a special type of connector for your mask. It has a port in the elbow that your bronch can fit through. Alternatively it is possible to place the bronch through while using nasal cannula only.

Equipment

 

Trach sweivel connector: item number 906857. It's clear with a tan peice for the bronch to go into; this is the piece you want
Trach Swivel Connector: item number 906857. It is clear with a tan piece for the bronch to go into.

 

here it is connected to a mask for mask ventilation. The other end will fit the vent tubing.
Here it is connected to a mask for mask ventilation. The other end will fit the vent tubing.

 

The piece you don't want
This is the piece you DON'T want if you can help it. It's also called a swivel connector but it won't fit into a mask directly without an interposed straight connector. It's less than ideal but it will work in a pinch if your flexible bronch is long enough.

Sleep Endoscopy Grading Scale

To identify the level of obstruction present and the severity of the obstruction please use the following template (modified from Chan et al 2014). Total Score: *** (max possible = 12)

Chan-Parikh score

Anatomic Level

 0 (no obstruction)

 +1 (partial obstruction)

 +2 (complete obstruction)

Nasal Airway   
Nasopharynx   
Velopharynx   
Oropharynx   
Hypopharynx   
Arytenoids   

 

References

Manickam, P. V., Shott, S. R., Boss, E. F., Cohen, A. P., Meinzen-Derr, J. K., Amin, R. S. and Ishman, S. L. (2016), Systematic review of site of obstruction identification and non-CPAP treatment options for children with persistent pediatric obstructive sleep apnea. The Laryngoscope, 126: 491–500. doi:10.1002/lary.25459

Chan DK, Liming BJ, Horn DL, Parikh SR. A New Scoring System for Upper Airway Pediatric Sleep Endoscopy. JAMA Otolaryngol Head Neck Surg. 2014;140(7):595-602. doi:10.1001/jamaoto.2014.612

Gallery
Trach sweivel connector: item number 906857. It's clear with a tan peice for the bronch to go into; this is the piece you want
here it is connected to a mask for mask ventilation. The other end will fit the vent tubing.
The piece you don't want