How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy

Abstract

Objective: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). Study Design: Online survey. Method: A sample of pediatric anesthesiologists received the survey by email. Results: 110 respondents were included. 46.4% worked in a free-standing children’s hospital and 32.7% worked in a children’s facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children’s hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA ( P < 0.05). Conclusion: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.

Effects of an individualized analgesia protocol on the need for medical interventions after adenotonsillectomy in children: a randomized controlled trial

“…Late use of fentanyl may also be different from many other practices. Intraoperative opioid use varies, and some practitioners do not utilize any opioids in this kind of surgery, as evidenced by the survey of Roberts et al [11]. Unconsciousness, immobility, and the control of autonomic nervous system responses to nociception can also be guaranteed with potent inhalational anesthetics only, since opioids are dispensable for general anesthesia [12].…”

Effects of Premedication With Midazolam on Recovery and Discharge Times After Tonsillectomy and Adenoidectomy

“…Many institutions have created their own guidelines for sedative use in children at their hospitals. An online survey of 110 pediatric anesthesiologists conducted by Roberts et al indicated that 27.3% of respondents reported that their institutions had such guidelines for perioperative management of children with OSA undergoing T&A, and that while 53.6% of respondents administered oral midazolam preoperatively in patients with severe OSA, 24.5% typically withheld the premedication [18].…”

The high-risk pediatric patient for ambulatory surgery

“…A survey by Roberts et al . [37] of pediatric anesthesiologists found that children with OSA were regularly encountered at both the main hospital and ASC, but were more likely to be diagnosed with OSA when scheduled at the main hospital.…”

“…Careful screening enhances safety and efficiency, and helps determine management based on facility expertise and staffing ratios. A survey by Roberts et al [37] of pediatric anesthesiologists found that children with OSA were regularly encountered at both the main hospital and ASC, but were more likely to be diagnosed with OSA when scheduled at the main hospital.…”