Post-Operative Apnoea

Post-operative apnoea:

• Describes recurrent periods of apnoea, with or without bradycardia
• Is a serious anaesthetic complication
• May occur in neonates, particular preterm infants with a PCA ⩽ 60 weeks

Epidemiology and Risk Factors

At-risk infants include:

• Premature
• Multiple congenital abnormalities
• Previous apnoea
• Chronic lung disease
• Bradycardia
• Anaemic ⩽100g/L
• Neurological disease

Pathophysiology

Multifactorial, but believed to be the combination of:

• Prematurity Strong association.
  • Elevated risk if PCA ⩽60
  • ⩽1% risk if PCA ⩽56
  • Highly significant if ⩽52.
• Immature respiratory centre
  • Impaired response to:
    • ↓ PO₂
    • ↑ PCO₂
• Hypothermia
• Anaemia
• Respiratory muscle fatigue

Clinical Manifestations

Occurrence of apnoea is:

• Most common in first 4-6 hours post-operatively
• Possible up to 12 hours

Management

Avoid outpatient surgery for any child who has:

• Apnoeas
• A history of apnoeas
• Anaemic

Inpatient admission:

• Requirement varies depending on hospital
• Multiple approaches exist
• Monitored observation includes:
  • Continuous SpO₂
  • Line of sight nursing
    
  • A plan to stimulate the child to resume respiration
• Conservative:
  • Admitting all infants <60 weeks for 24 hours of monitored observation
  • Admit and monitor all infants for 12 hours after surgery
• Tiered:
  • Otherwise well infants can be monitored for 6 hours post-operatively
  • Infants with apnoeas, lung disease, neurological disease, or anaemia should be monitored for 12 hours
  • Former pre-term infants should be referred to a specialist paediatric centre

Anaesthetic Considerations

• D
  • Use of regional anaesthesia
    May reduce risk.

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References

1. Walther-Larsen S, Rasmussen LS. The former preterm infant and risk of post-operative apnoea: recommendations for management. Acta Anaesthesiol Scand. 2006 Aug;50(7):888–93.