An observational prospective study for drug protocol in DISE in Paediatric population

The goal of DISE is to determine an anatomic site of obstruction for children with OSA. Literature shows, there is a low rate of agreement on how to perform DISE. Although many institutions have a standard DISE drug protocol, none has been widely accepted. This wide variability of DISE protocol compromises DISE findings which in turn affect patient Management. This study aims at deriving a standard drug protocol to perform DISE at our institution. After pre-operative assessment of patients, the pre-existing medical conditions and drug allergies will be noted and they will be premedicated with Syrup trichloryl 75 mg/kg one hour prior to entry to OR (Operating room). They will be monitored by a pulse oximeter. On receiving the patient in OR, they will be kept in a quiet room with dimmed lights with few people. Child will be induced with inhalational agents (Sevoflurane + Nitrous oxide + Oxygen) and peripheral IV catheter will be placed once patient is in deep plane of anaesthesia. Dexmedetomidine infusion will be administered at 0.5mcgs/kg IV over 10 minutes. Ketofol (ketamine 100-200 mcg/kg/min + propofol 50-100 mcg/kg/min ) will be titrated according to the BIS value between 65-85(8) and attempt to insert scope will be made. Patient vitals (heart rate, respiratory rate, blood pressure, saturation) will be monitored during the procedure and additional use of extra doses of ketofol will be documented. Patient’s sedation level will be monitored using BIS monitor and time taken to complete the study will be documented. Any untoward events or other factors hindering the successful completion of study will be taken into account. Following DISE, the patient will undergo the proposed procedure, adenoidectomy or tonsillectomy according to the standard protocol. If patient is posted only for DISE, patient will be monitored in recovery room and discharged according to modified Aldrete score.