Investigation on upper airway collapsibility and postoperative nocturnal breathing in children

本研究的目的是评估幼儿术后晚期由上气道阻塞引起的夜间去饱和的发生率和意义，并比较幼儿与成人的上气道塌陷。虽然由于这些幼儿的血氧饱和度测量不可靠，我们未能完成术后夜间血氧饱和度的研究，但我们完成了全身麻醉下肌肉麻痹的幼儿咽萎性的评估。我们发现婴儿有更多的折叠咽比成人，咽气道稳定在第一年的生活。最有趣的是，俯卧位增加了婴幼儿咽部塌陷。我们的研究结果表明，成熟程度和体位对术后夜间呼吸异常有重要影响。此外，俯卧位增加的咽部塌陷性可能是SIDS患者患病率较高的关键证据。由于我们的研究是在全身麻醉下进行的，完全肌肉麻痹，我们缺乏关于神经肌肉机制补偿上气道阻塞的作用的知识。未来的研究应针对这些儿童的神经肌肉机制的贡献进行调查。

The purposes of this investigation were to assess prevalence and significance of late post-operative nocturnal desaturations caused by upper airway obstruction in small children, and to compare upper airway collapsibility in small children with adults. While we failed to complete the study on post-operative nocturnal desaturations because of unreliable measurements of oxygen saturation in these small children, we completed the evaluation of pharyngeal collapsibility in small children under general anesthesia with muscle paralysis. We found that infants had more collapsible pharynx than adults, and the pharyngeal airway was stabilized within the first year of life. Most interestingly, prone position increased the pharyngeal collapsibility in infants and small children. Our findings indicate that maturation and body position significantly contribute to post-operative nocturnal breathing abnormality. Furthermore, increased pharyngeal collapsibility by the prone position may give a key evidence for the higher prevalence of SIDS victims. Because our study was performed under general anesthesia with total muscle paralysis, we lack knowledge on a role of neuromuscular mechanisms compensating the upper airway obstruction. Future studies should be directed to investigate contribution of the neuromuscular mechanisms in these small children.