Adenotonsillectomy and postoperative respiratory adverse events: A retrospective study

Abstract

Objectives Postoperative respiratory adverse events (PRAEs) are known complications following adenotonsillectomy (AT). Clinical data at a single institution were reviewed to investigate the factors that may contribute to PRAEs in the postanesthesia care unit (PACU). The relationship between PRAEs in the PACU and escalation of care, defined as either an unplanned admission for outpatient surgery or unplanned pediatric intensive care unit (PICU) admission, was investigated. Methods The perioperative records for all patients who underwent AT from 2016 to 2018 were reviewed. The surgical procedure was performed at both the main campus and the ambulatory surgery center in accordance with the institutional obstructive sleep apnea (OSA) guidelines. Patient characteristics and intraoperative medications were compared. Categorical variables were summarized as counts with percentages and compared using chi‐square tests or Fisher's exact tests. Continuous variables were summarized as medians with interquartile ranges and compared using rank‐sum tests. Multivariable logistic regression was performed to evaluate the association of intraoperative dosing with the occurrence of PRAEs. Results The study cohort included 6110 patients. Ninety‐three patients (2%) experienced PRAEs in the PACU. Of these 93 patients, 14 (15%) resulted in an escalation of care, nearly all of which were unplanned PICU admissions. PRAEs tended to occur in younger patients, non‐Hispanic black patients, and those with a higher American Society of Anesthesiologists (ASA) status. Conclusions PRAEs are infrequent after AT at a tertiary institution with OSA guidelines in place. However, when PRAEs do occur, escalation of care may be required. Risk factors include age, ethnic background, and ASA physical status. Level of Evidence III.

Day‐case discharge criteria and safety of children undergoing adenoidectomy and tonsillectomy for obstructive symptoms—A systematic review

“…2,4,[8][9][10][11][12][13][14][15][16][17][18][19][20] See Figure 1 for a PRISMA flow diagram illustrating the study selection process. 2,4,[8][9][10][11][12][13][14][15][16][17][18][19][20] All included studies were observational: 14 retrospective and one prospective. 12 One study had a control group for outcome comparison.…”

“…The remaining six studies reported on post-operative complications within the first 24 h, although it was unclear what proportion of these patients underwent the procedure as a day case. 4,[10][11][12]16,18 Four studies stratified patients by comorbid and functional status using the American Society of Anaesthetists (ASA) scale, within these studies, the ASA ranged from 1 to 3. [15][16][17][18]…”

Considerations in Surgical Management of Pediatric Obstructive Sleep Apnea: Tonsillectomy and Beyond

“…Respiratory complications can occur intra-operatively, in the PACU, or post-operatively. Major respiratory complications include bronchospasm, laryngospasm, post-obstructive pulmonary edema, airway obstruction, aspiration pneumonitis, pneumonia, or cardiopulmonary arrest [8,51]. These events typically result in reintubation, CPAP/BIPAP therapy, placement of a nasopharyngeal or oropharyngeal airway, bag mask ventilation, an unplanned admission of the patient to the hospital, elevation of care to the intensive care unit (ICU), pulmonary edema, or, rarely, death [52].…”

“…There are certain patient specific risk factors for hypoxemia within the first 24 h post-operatively that have been identified. These include patients with Trisomy 21, obesity, age, black race, coexistent cardiac disease, clinical diagnosis of OSA, coexistent neurologic disease, or a prior diagnosis of pulmonary disease [50,51,53]. Given the lack of standardization in the literature defining what exactly characterizes a hypoxic event, the reported incidence varies from 5% to 30%, with a meta-analysis reporting a 9.4% overall incidence [50].…”

<p>Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study</p>

“…[3][4][5] For these patients, the decision to undergo these otolaryngologic procedures and the use of perioperative opioids often mandates prolonged periods of observation or overnight hospital admission due to the potential risk of postoperative respiratory depression. 6,7 An opioid-sparing anesthetic technique includes adjunctive non-opioid agents using a multi-modal approach employing a combination of non-opioid medications which target various analgesic pathways. 8 These techniques are becoming more popular not only to decrease the incidence of adverse effects related to opioids, but in identifying clinical opportunities to minimize opioid use amidst the backdrop of the national opioid crisis which affects both the adult and pediatric population.…”