Introduction:
Coronavirus disease (Covid-19) was first discovered in December 2019 with no signs of conceding to date. Many operations which are regarded as not lifesaving are postponed indefinitely owing to hospital bed shortage as well as to reduce the spread of infection among patients and staff. However, healthcare professionals are thrown down a huge challenge when deciding the timing of treatment for non-life-threatening conditions like severe paediatric obstructive sleep apnoea syndrome (OSAS) with a substantial impact on the development of very young children.

Aim:
To outline management of postoperative respiratory complication in a child with severe obstructive sleep anoea syndrome during Covid-19.

Case study:
We present a case of a major respiratory event requiring reintubation that developed post-adenotonsillectomy in a 3-year-old child with severe OSAS.

Results and discussion:
The child was given close monitoring for 6 h in the post-anaesthetic care unit (PACU) before he was transferred to the general paediatric ward, without PICU admission during his stay in the hospital.

Conclusions:
Postoperative monitoring at the step-down unit with a high nurse-to-patient ratio appears to be beneficial as it does not compromise the need for close postoperative observation, meanwhile saving costs.