Links and risks associated with adenotonsillectomy and obesity

Abstract

Adenotonsillectomy (A&T) is a very common surgical procedure in children. Over the past 20 years the principal indication for A&T in children has changed from recurrent adenotonsillitis to obstructive sleep apnea. The physiopathology of obstructive sleep apnea syndrome (OSAS) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. On the other hand, the prevalence and severity of childhood obesity have become a veritable epidemic problem in the past 30 years. So the increasing prevalence of obesity in children and high prevalence of obstructive sleep apnea in obese children implies that an increasing number of these children will present for A&T. Due to more prevalent anatomical alterations of the oronasopharyngeal airways, it is often difficult to predict operation success in obese children. However, previous studies supports that although the risk of presence of residual symptoms of OSAS and airway-related perioperative complication in obese may be more than nonobese group, A&T is effective to reduce obstructive symptoms and improve quality of life in obese children with OSAS.

Insights into Pediatric Sleep Disordered Breathing: Exploring Risk Factors, Surgical Interventions, and Physical and Scholastic Performance at Follow-Up

“…At a follow-up appointment, children with recurrent tonsillitis more frequently underwent an A&T rather than an adenoidectomy [18]. Recurrent tonsillitis can serve as an indication for tonsillectomy based on specific criteria outlined by medical guidelines [33]. Finally, a reduced percentage of children with a history of recurrent otitis media and hearing loss had persistent SDB after adenoidectomy surgery [14].…”

Knowledge and Awareness Among Parents of Pediatric Patients Regarding the Complications of Recurrent Adenotonsillitis and Its Surgical Treatment

“…Moreover, evidence has shown that adenotonsillectomy does not cause obesity or weight gain. On the contrary, studies have proven that it is effective in reducing obstructive symptoms in obese children and improving their quality of life [ 23 ]. Chronic neglected adenotonsillitis has been associated with serious complications, such as pulmonary hypertension, cor pulmonale, and heart failure [ 24 ], with other studies showing an association between gastroesophageal reflux disease and recurrent adenotonsillitis [ 25 ].…”

Perioperative management of patients with concomitant morbid obesity. Guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”

“…МЕТОДИЧЕСКИЕ РЕКОМЕНДАЦИИ летальность в возрасте [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]…”

“…Особенности периоперационного периода при ОСА и синдроме гиповентиляции [27]: ÿ повышенная чувствительность к снотворным и седативным препаратам, а также опиоидам; ÿ вероятность трудной масочной вентиляции и трудной интубации; ÿ вероятность быстрой десатурации при индукции анестезии; ÿ вероятность гиперкапнии во время анестезии.ň Рекомендация 5. У пациентов с ожирением рекомендуется оценка трудных дыхательных путей[28][29][30][31] (УДД -2, УУР -А).…”