Adenotonsillectomy and postoperative respiratory adverse events: A retrospective study

Thomas B Hamilton, Arlyne Thung, Joseph D Tobias, Kris R Jatana, Vidya T Raman, Thomas B Hamilton, Arlyne Thung, Joseph D Tobias, Kris R Jatana, Vidya T Raman

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.

Keywords: adenotonsillectomy; hypoxemia; laryngospasm; respiratory; tonsillectomy.

Conflict of interest statement

T.B.H., A.T., J.D.T., and V.T.R. declare no potential conflict of interest. K.R.J. receives royalties from Marpac, Inc. for a patented tracheostomy collar design, commercially available, and from a product safety medical consultant, Intertek, Inc.

© 2019 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.

Figures

Figure 1
Figure 1
Division of patients with a postoperative respiratory adverse event (PRAE)
Figure 2
Figure 2
Risk stratification for patients undergoing adenotonsillectomy (AT)

References

    1. Cohen N, Sommer DD. Post‐tonsillectomy pain control: consensus or controversy? Pain Manage. 2016;6:31‐37.
    1. De AJ, Waltuch TP, Gonik NR, et al. Sleep and breathing the first night after adenotonsillectomy in obese children with obstructive sleep apnea. J Clin Sleep Med. 2017;13(06):805‐811.
    1. Nixon GM, Kermack AS, Mcgregor CD, et al. Sleep and breathing on the first night after adenotonsillectomy for obstructive sleep apnea. Pediatr Pulm. 2005;39(4):332‐338.
    1. Arambula AM, Xie DX, Whigham AS. Respiratory events after adenotonsillectomy requiring escalated admission status in children with obstructive sleep apnea. Int J Pediatr Otorhinol. 2018;107:31‐36.
    1. Subramanyam R, Yeramaneni S, Hossain MM, Anneken AM, Varughese AM. Perioperative respiratory adverse events in pediatric ambulatory anesthesia. Anesth Analg. 2016;122:1578‐1585.
    1. Tweedie DJ, Bajaj Y, Ifeacho SN, et al. Peri‐operative complications after adenotonsillectomy in a UKpediatric tertiary referral centre. Int J Pediatr Otorhi. 2012;76(6):809‐815.
    1. Brown KA, Laferrière A, Moss IR. Recurrent hypoxemia in young children with obstructive sleep apnea is associated with reduced opioid requirement for analgesia. Anesthesiology. 2004;100:806‐810.
    1. Brown KA, Laferrière A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology. 2006;105:665‐669.
    1. Nafiu OO, Shanks A, Abdo S, Taylor E, Tremper TT. Association of high body mass index in children with early post‐tonsillectomy pain. Int J Pediatr Otorhinolaryngol. 2013;77:256‐261.
    1. Sadhasivam S, Chidambaran V, Olbrecht VA, et al. Opioid‐related adverse effects in children undergoing surgery: unequal burden on younger girls with higher doses of opioids. Pain Med. 2015;16:985‐997.
    1. Kako H, Tripi J, Walia H, et al. Utility of screening questionnaire and polysomnography to predict postoperative outcomes in children. Int J Pediatr Otorhinolaryngol. 2017;102:71‐75.
    1. Hadden SM, Burke CN, Skotcher S, Voepel‐Lewis T. Early postoperative outcomes in children after adenotonsillectomy. J Perianesth Nurs. 2011;26:89‐95.
    1. Zhuang PJ, Wang X, Zhang XF, Zhou ZJ, Wang Q. Postoperative respiratory and analgesic effects of dexmedetomidine or morphine for adenotonsillectomy in children with obstructive sleep apnoea. Anaesthesia. 2011;66:989‐993.
    1. Bellon M, Bot AL, Michelet D, et al. Efficacy of intraoperative dexmedetomidine compared with placebo for postoperative pain management: a meta‐analysis of published studies. Pain Ther. 2016;5:63‐80.
    1. Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryng Head Neck. 2019;160:S1‐S42.
    1. Lawlor CM, Riley CA, Carter JM, Rodriguez KH. Association between age and weight as risk factors for complication after tonsillectomy in healthy children. JAMA Otolaryngol. 2018;144:399‐405.
    1. Tariq S, Syed M, Martin T, Zhang X, Schmitz M. Rates of perioperative respiratory adverse events among Caucasian and African American children undergoing general anesthesia. Anesth Analg. 2018;127:181‐187.
    1. Lavin JM, Shah RK. Postoperative complications in obese children undergoing adenotonsillectomy. Int J Pediatr Otorhinol. 2015;79:1732‐1735.
    1. Raman VT, Jatana KR, Elmaraghy CA, Tobias JD. Guidelines to decrease unanticipated hospital admission following adenotonsillectomy in the pediatric population. Int J Ped Otorhinol. 2014;78:19‐22.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe