ABSTRACT
BACKGROUND: When to order an echocardiogram in children with obstructive sleep apnea (OSA) is debated. Studies evaluating the utility of pre-operative standard echocardiography are inconsistent. Tissue Doppler imaging (TDI) is an additional technique that quantifies the velocity of myocardial motion to assess cardiac function. The utility of TDI in pediatric OSA remains unclear. METHODS: A systematic review and meta-analysis were performed in accordance with PRISMA guidelines using PubMed, Scopus, CINAHL, and Cochrane Library databases. Studies of echocardiographic findings using TDI in children with polysomnogram confirmed OSA before and after tonsillectomy and adenoidectomy (T&A) were included. 1,423 studies were screened, and 4 studies met inclusion criteria. Meta-analysis of echocardiographic findings was performed. RESULTS: Data from 560 children were analyzed. Study groups included pre- and post-T&A children with OSA and non OSA controls. Pre-T&A S' wave at the tricuspid annulus (S' RV) was decreased with a mean difference of -1.04 [95% CI -1.57, -0.52, p < 0.001] and E'/A' ratio at the mitral annulus (E'/A' LV) was decreased with a mean difference of -0.74 [95% CI -0.85, -0.64, p < 0.001] when compared to controls. These variables were not statistically different when comparing post-T&A to controls. CONCLUSIONS: TDI appears to successfully detect subclinical changes in cardiac function in children with OSA. However, echocardiography parameters of post-T&A and non OSA control children were similar. Further prospective studies stratified by OSA severity are needed with both TDI and standard echocardiography to define the utility of pre-operative cardiac imaging.
Subject(s)
Sleep Apnea, Obstructive , Tonsillectomy , Adenoidectomy , Child , Echocardiography, Doppler , Humans , Prospective Studies , Sleep Apnea, Obstructive/diagnostic imaging , Sleep Apnea, Obstructive/surgeryABSTRACT
BACKGROUND: Postoperative posterior ischemic optic neuropathy (PION) is a rare cause of postoperative vision loss, most often seen when surgical patients are placed in the prone position for a prolonged period of time. We report a case of bilateral PION after far-lateral craniectomy in the lateral position. CASE DESCRIPTION: A 36-year-old man presented with a history of right extremity numbness, weakness, and muscle atrophy, and a craniocervical meningioma was diagnosed. Surgery in the lateral position lasted 9 hours, 52 minutes; the patient had 2 L of blood loss. On postoperative day 1, the patient had bilateral vision loss, which prompted further work-up. Diffusion-weighted imaging of the orbits demonstrated restricted diffusion within the bilateral optic nerves. The clinical presentation of painless vision loss after surgery with these imaging findings led to a diagnosis of PION. At the time of discharge, he had not recovered any visual function. CONCLUSIONS: This case suggests that PION can occur in the lateral position where there is no direct pressure on the orbits. PION is often not discussed as a potential complication during the preoperative consent process. This case suggests it may be prudent to discuss PION in similar neurosurgical cases. Intraoperative blood transfusion should be considered in prolonged surgeries in the lateral position, where slow blood loss over a long period could be a contributing factor to development of PION.
