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The Challenges of Pediatric Anesthesia for Ambulatory Adenotonsillectomy

  • Ambulatory Anesthesia (GP Joshi, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of review

With a prevalence of about 10%, pediatric sleep-disordered breathing (PSDB) contributes to significant epidemiological burden. The first line of management is adenotonsillectomy (AT), which restores airflow and leads to resolution of symptoms in over 80% of children. Providing safe and effective administration of general anesthesia in this ‘at risk’ population can be a challenge in the ambulatory setting.

Recent findings

Safe and effective administration of general anesthesia as well as pain management in children undergoing AT is contingent upon early recognition of risk factors and choosing the right combination of anesthetic and analgesic medications. The use of opioid-sparing techniques and increased alertness on the part of the practitioner to the potential complications of undiagnosed severe OSA are crucial.

Summary

Pediatric sleep-disordered breathing (PSDB) represents a spectrum of disorders that result from varying degrees of upper airway obstruction during sleep. These disorders range from primary snoring (PS), to obstructive sleep apnea (OSA) of varying degrees and all are treated with adenotonsillectomy (AT) which results in resolution of symptoms in vast majority of children. Over half a million tonsillectomies are performed each year in the US (Roland et al. in Otolaryngol Head Neck Surg 145:S1–15, 2011), with most completed in an ambulatory setting without laboratory investigations preceding surgery. Because of the wide spectrum that PSDB encompasses, it is important to be mindful of the varying risks that this population can have in the ambulatory surgery setting.

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Author information

Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center and Children’s HealthSM, Dallas, TX, USA

    Amal Isaiah

  2. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center and Children’s HealthSM, 1935 Medical Center Drive, Dallas, TX, 75234, USA

    Peter Szmuk, Huy Do, Adolfo Gonzalez & Jeffrey W. Steiner

  3. Outcomes Research Consortium, Cleveland, USA

    Peter Szmuk & Jeffrey W. Steiner

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  1. Amal Isaiah
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Correspondence to Jeffrey W. Steiner.

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Amal Isaiah, Peter Szmuk, Huy Do, Adolfo Gonzalez, and Jeffrey W. Steiner declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical collection on Ambulatory Anesthesia.

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Isaiah, A., Szmuk, P., Do, H. et al. The Challenges of Pediatric Anesthesia for Ambulatory Adenotonsillectomy. Curr Anesthesiol Rep 6, 354–361 (2016). https://doi.org/10.1007/s40140-016-0178-1

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