Expert: Dr Ian Jackson - please note UK based - 11/20/2010

Question
QUESTION: Hi,
My 2 and a half year old daughter went under general anesthesia for an adenoidectomy. Upon her return, her surgeon advised me that her breathing was laboured during the procedure and her O2 levels had dropped.. and thus she may need a sleep study. I then spoke to the Anesthesiologist who advised me that they weren't low. Due to this confusion I asked to see the OP OBs and they showed that her O2 levels were at a constant 73% for most of the procedure.

She has a heart murmur which has thus far been described as a "flow" murmur. I would like to know if such low level of O2 is normal whilst under? I ask this because they have advised that she may need her tonsils out in a few months and I don't know if I'd like her going under again. She has had echos in regards to the murmur coupled with central cyanosis that have shown a normal heart and function. Would you recommend re-doing the echo or getting a second opinion? I am not aware of the type of anesthetic that was used but she first had gas and then IV. I do own an oximeter and her O2 levels have always been 95% and higher whilst at rest or upon exertion.

Any light you could shed on this would be greatly appreciated.

Thank you.


ANSWER: Hi there
Firstly there is no need for your daughter to have another echo. If everything was fine with the last one then her murmur is an innocent flow murmur. There is no indication for anything else there, be reassured her heart is fine.

It is unusual for children to have low saturations during anaesthesia but it can quickly happen as they have very little reserve of oxygen in their small lungs. You don't say which country you are in but I would guess that you are outside the UK?

I ask this as standard ways of doing procedures varies around the world. It is a bit technical but I suspect your daughter just had some anaesthetic gases from a mask during her op. The blood from the procedure would have tended to make things a bit difficult for the anaesthetist and she may well have a relatively small airway through which to breathe and this may have caused her sats to fall.

Bottom line. Does she really need another op? I would ask for another opinion about that - why do they need to come out. I certainly wouldn't be happy for this to be done without a very good reason.

Kind regards
Dr Ian Jackson



---------- FOLLOW-UP ----------

QUESTION: Thank you for your response Dr.

We reside in Australia. She initially required her adenoids to be removed as they were enlarged and she got ill three times in 2 months (once with pneumonia and twice viral) for which she was hospitalised. She also has febrile convulsions. They advised to remove them as to reduce the amount of times she was getting sick. Also she sometimes snores at night and is quite nasal in her speech.

Before the surgery we were told her tonsils were not large enough to justify removal but apparently during surgery they realised they were larger than initially thought. They told me they may have to be removed as she may have sleep apnea or she may continue to get sick. In saying that she has never had a cough or infected tonsils.

Should I need to worry about anaesthesia in the future for her or could it be that at the moment she's too small anatomically? Is the 73% saturation dangerous enough to consider not sending her under? In this situation, in your opinion which out-weighs the other?

Thanking you again.  

Answer
Hi there
It is helpful to know where you are and the extra info you have provided. I am less concerned now about the procedure as you are in a Country with excellent medical staff.
I am sure the issue this time has been related to her size and as I mention it is very easy for small children like this to desaturate to the levels seen and it can be difficult to get those levels back up during the procedure. It is every anaesthetists nightmare. Small child and often with quite a lot of secretions which on top of the small airway and limited reserve makes for a difficult time.
I would be guided by the clinicians looking after your child. However I would take a stance that you need to be convinced that the operation is necessary.
For what it's worth my daughter had her tonsills out as we were concerned about her relative 'failure to thrive' and snoring plus obstructing at times i.e. sleep apnoea. However we waited until she was 8 before finally decided to go down this route. We remain convinced that it was the right decision and she has done well but we will never really know if the op really made any difference.
Kind regards
Dr Ian Jackson