Predictive Factors for Respiratory Complications After Tonsillectomy and Adenoidectomy in Children

Biavati, Michael J.; Manning, Scott C.; Phillips, Debra

doi:10.1001/archotol.1997.01900050067009

Cited by 122 publications

(41 citation statements)

References 16 publications

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“…Previous literature also supports the finding that patients with an American Society of Anesthesia score of more than 2 require an overnight stay. 16,17 These results are largely in agreement with the UK consensus statement on tonsillectomy in children published in 2009.mandatory stay was 0.19 per cent (n = 5) in the current study sample. This suggests that the vast majority of patients can be safely discharged home following their procedure, with only a fraction expected to represent in the first 24 hours with a serious complication.…”

supporting

confidence: 91%

“…This was a statistically significant finding, and is in line with other literature suggesting that being two years of age or less is a major risk factor for post-tonsillectomy complications and should always indicate a mandatory overnight stay. 10,[16][17][18] Neoplasm and quinsy were over-represented in those patients who experienced a major bleed with a return to the operating theatre, and were statistically significantly associated with haemorrhage and airway compromise. Previous literature also supports the finding that patients with an American Society of Anesthesia score of more than 2 require an overnight stay.…”

mentioning

confidence: 99%

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Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention

2017

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Objective: The safety of day-case tonsillectomy is widely documented in the literature; however, there are no evidence-based guidelines recommending patient characteristics that are incompatible with day-case tonsillectomy. This study aimed to identify which patients should be considered unsafe for day-case tonsillectomy based on the likelihood of needing critical intervention.Method: Retrospective review of 2863 tonsillectomy procedures performed at University Hospital Geelong from 1998 to 2014.Results: Of the patients, 7.81 per cent suffered a post-tonsillectomy complication and 4.15 per cent required intervention. The most serious complications, haemorrhage requiring a return to the operating theatre and airway compromise, occurred in 0.56 per cent and 0.11 per cent of patients respectively. The following patient characteristics were significantly associated with poorer outcomes: age of two years or less ( p < 0.01), tonsillectomy indicated for neoplasm ( p < 0.01) and quinsy ( p < 0.05).Conclusion: The authors believe that all elective tonsillectomy patients should be considered for day-case surgery, with the following criteria necessitating overnight observation: age of two years or less; an indication for tonsillectomy of neoplasm or quinsy; and an American Society of Anesthesia score of more than 2.

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supporting

confidence: 91%

mentioning

confidence: 99%

Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention

2017

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“…This profile includes age below 3 years, failure to thrive, obesity, cardiac complications such as right ventricular hypertrophy, craniofacial anomalies, neuromuscular disease, severe OSA, and sleep O 2 saturations <80%. 11,12,22 Although a low number of patients was studied, we found that the majority of them developed at least one postoperative complication. Preoperatively, 2 patients were younger than 3 years of age, 3 patients had an AHI greater than 10 events/hr, and all patients had nadir oxygen saturation levels below 80%.…”

Section: Discussionmentioning

confidence: 83%

“…11,12 Preoperative sleep studies and postoperative overnight observation were recommended for patients at high risk for postoperative complications. 12 Many studies were previously published about sleepdisordered breathing (SDB) in PWS. Nevertheless, few data are available about adenotonsillectomy for the treatment of OSA in these patients.…”

Section: Introductionmentioning

confidence: 99%

Adenotonsillectomy for Obstructive Sleep Apnea in Children with Prader‐Willi Syndrome

Pavone

Paglietti

Petrone

et al. 2005

Pediatric Pulmonology

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Summary. The aim of our study was to evaluate the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea syndrome (OSA) in pediatric patients with Prader-Willi syndrome (PWS), and to describe the postoperative complications. Five patients (4 males; median age, 4.4 years; range, 1.6-14.2 years) were studied. All patients underwent an overnight cardiorespiratory sleep study. All patients had adenotonsillar hypertrophy (ATH), and two were also obese. The preoperative obstructive apnea/hypopnea index (AHI; median and range) was 12.2 (9.0-19.9) events/hr; the mean oxygen saturation was 95 (79-96)%; the nadir oxygen saturation was 71 (58-78)%; and the oxygen desaturation index (ODI) was 15.8 (11.4-35.9) events/hr. Preoperatively, patients were classified as having moderate to severe OSA. A second sleep study, performed 16 (3-43) months after adenotonsillectomy, showed a significant decrease in AHI (P ¼ 0.009) and ODI (P ¼ 0.009). Mean and nadir oxygen saturation did not differ significantly postsurgery (P ¼ 0.188, P ¼ 0.073, respectively). Four out of five children showed at least one postoperative complication. Difficult awakening from anesthesia, hemorrhages, and respiratory complications requiring reintubation and/or supplemental oxygen administration were observed. In conclusion, patients with PWS and OSA who underwent adenotonsillectomy showed a significant decrease in AHI and number of oxygen desaturations. Pediatr Pulmonol. 2006; 41:74-79.

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“…Patients were excluded if they had a condition known to increase the incidence of postoperative respiratory complications, including active upper respiratory tract infection, moderate to severe asthma, age less than two years, American Society of Anesthesiologists' physical status III or above, cerebral palsy, craniofacial anomalies, chronic cardiopulmonary disease, a history of seizures, a history of prematurity, hypotonia, and failure to thrive. [3][4][5] ''Deep'' tracheal extubation was presumed when anesthesia records showed an age-appropriate end-tidal anesthetic concentration C 1.0 minimum alveolar concentration at extubation. Three time intervals were recorded: time from surgery end to exiting the operating room (out of operating room time), time from exiting the operating room to re-entering with the next patient (turnover time), and time from the end of surgery to transfer of anesthesia care to postanesthesia care unit (PACU) personnel (anesthesia end time).…”

Section: To the Editormentioning

confidence: 99%

The effect of deep and awake tracheal extubation on turnover times and postoperative respiratory complications post adenoid-tonsillectomy

Menda

Gregory

Feiner

et al. 2012

Can J Anesth/J Can Anesth

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To the Editor,Tonsillectomies and adenoidectomies (T&As) are increasingly performed in an outpatient setting in order to increase time efficiency with rapid turnover between cases.1 Though Patel et al. showed no difference in postoperative respiratory complications between deep and awake tracheal extubation after T&A, there remains considerable debate amongst pediatric anesthesiologists concerning which extubation technique is safer and more efficient. 2 We undertook a retrospective review of T&As in our institution to examine whether one method of tracheal extubation (deep or awake) saved time in the operating room and reduced turnover time. We also examined differences between extubation techniques relating to postoperative respiratory complications following T&A.After approval by the Committee on Human Research on March 29, 2012, we reviewed the charts of all \ 18-yr-old patients who underwent tonsillectomy, adenoidectomy, or both over a one-year period at the University of California San Francisco Benioff Children's Hospital Ambulatory Surgery Center. Inclusion criteria included otherwise healthy patients with a primary surgical diagnosis of sleepdisordered breathing, chronic nasal congestion, recurrent tonsillitis, recurrent otitis media, or hearing loss/speech delay. A single surgeon performed all procedures and pediatric anesthesiologists, usually with a resident, provided the anesthesia. Patients were excluded if they had a condition known to increase the incidence of postoperative respiratory complications, including active upper respiratory tract infection, moderate to severe asthma, age less than two years, American Society of Anesthesiologists' physical status III or above, cerebral palsy, craniofacial anomalies, chronic cardiopulmonary disease, a history of seizures, a history of prematurity, hypotonia, and failure to thrive. [3][4][5] ''Deep'' tracheal extubation was presumed when anesthesia records showed an age-appropriate end-tidal anesthetic concentration C 1.0 minimum alveolar concentration at extubation. Three time intervals were recorded: time from surgery end to exiting the operating room (out of operating room time), time from exiting the operating room to re-entering with the next patient (turnover time), and time from the end of surgery to transfer of anesthesia care to postanesthesia care unit (PACU) personnel (anesthesia end time). Significant respiratory complications requiring an anesthesia provider's assessment and/or management were collected from the PACU record, including airway obstruction requiring jaw thrust and/or airway adjuncts, pulse oximetry reading \ 93% for more than two minutes (prolonged oxygen desaturation), bronchospasm, laryngospasm, bleeding episodes, and need for tracheal reintubation or admission to the intensive care unit.Sixty-two of the 110 patients who met the inclusion criteria underwent deep tracheal extubation and 48 patients underwent awake extubation. There were no statistically significant differences between groups for age, weight, sex, or opioid rece...

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Predictive Factors for Respiratory Complications After Tonsillectomy and Adenoidectomy in Children

Cited by 122 publications

References 16 publications

Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention

Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention

Adenotonsillectomy for Obstructive Sleep Apnea in Children with Prader‐Willi Syndrome

The effect of deep and awake tracheal extubation on turnover times and postoperative respiratory complications post adenoid-tonsillectomy

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