Urgent adenotonsillectomy for upper airway obstruction

Reversible cardio-pulmonary changes due to adeno-tonsilar hypertrophy

Adeno-tonsillar hypertrophy, with signs of upper airway obstruction is a common presentation in ENT clinics. Recently it is identified as a major cause of sleep apnea syndrome. Several isolated case reports of pulmonary hypertension and corpulmonale appeared in the literature. The authors report two such children aged less than 2 years with cardio-pulmonary changes occurring secondary to chronic adeno-tonsillar hypertrophy that were successfully treated with the surgical removal.

Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea

OBJECTIVES

a) To determine the need for intensive monitoring on the first operative night of surgery in children undergoing adenotonsillectomy for mild obstructive sleep apnea; b) to examine the effect of narcotics on postoperative obstructive sleep apnea.

DESIGN

Randomized, prospective study.

SETTING

University hospital.

PATIENTS

Children, ranging in age between 1 and 18 yrs, presented to the Pediatric Otolaryngology Clinic for adenotonsillectomy for mild obstructive sleep apnea defined as from one to 15 obstructive apnea events per hour on preoperative polysomnogram.

INTERVENTIONS

Patients were assigned to receive either a narcotic- or a halothane-based anesthetic for adenotonsillectomy. A postoperative polysomnogram was performed in the pediatric intensive care unit on the first operative night.

MEASUREMENTS AND MAIN RESULTS

Eighteen patients were recruited, 15 of whom met inclusion criteria: nine patients received a halothane-based anesthetic and six patients received a fentanyl-based anesthetic. When the data were analyzed by pooling both groups, the differences between pre- and postoperative sleep studies demonstrated a reduction in the number of obstructive events and less severe oxygen desaturations on the operative night. Total sleep time between the two sleep studies decreased from 371 +/- 13 to 304 +/- 14 mins. The number of obstructive apnea events/hr decreased as well. The lowest oxygen saturation measured during rapid eye movement sleep was 78 +/- 5% preoperatively and 92 +/- 1% postoperatively.

CONCLUSIONS

Our data suggest that children without underlying medical conditions, neuromotor diseases, or carniofacial abnormalities, 1 to 18 yrs of age, who suffer from mild obstructive sleep apnea, have improvements documented by polysomnography on the night of surgery following adenotonsillectomy and do not necessarily need to be monitored intensively. These findings were not significantly affected by the choice of intraoperative anesthetic.

Early adenotonsillectomy for relief of acute upper airway obstruction due to acute tonsillitis in children

Early adenotonsillectomy (TA) for acute upper airway obstruction precipitated by acute tonsillitis was performed in 17 children admitted to the Royal Childrens Hospital over a 15 year period. The age ranged from 13 to 83 months (mean 37 months) and surgery was performed from 1 to 11 days (mean 5.8 days) following admission. One child who underwent surgery within 24 h of admission had an intraoperative blood loss of 250 ml requiring transfusion, but there were no cases of post operative hemorrhage. Airway obstruction was relieved by surgery in all cases and patients were discharged 1 to 6 days (mean 2.4 days) later. Early TA should be considered for relief of upper airway obstruction due to acute tonsillitis after an initial 24 h of intravenous antibiotic therapy.