Perioperative respiratory complications following awake and deep extubation in children undergoing adenotonsillectomy

Baijal, Rahul G.; Bidani, Sudha A.; Minard, Charles G.; Watcha, Mehernoor F.

doi:10.1111/pan.12561

Cited by 68 publications

(56 citation statements)

References 17 publications

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“…Small children in general and particularly those with URTI are prone to experience PRAE (5,7,8,28). A recent randomised controlled trial shows that infants < 1 year especially benefit most from LMA over ETT in terms of occurrence of PRAE (29).…”

Section: Airway Managementmentioning

confidence: 99%

An update on the perioperative management of children with upper respiratory tract infections

Regli

Becke

Ungern‐Sternberg

2017

Current Opinion in Anaesthesiology

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Section: Airway Managementmentioning

confidence: 99%

An update on the perioperative management of children with upper respiratory tract infections

Regli

Becke

Ungern‐Sternberg

2017

Current Opinion in Anaesthesiology

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“…Perioperative respiratory complications following a T&A are relatively common and have been described to occur more frequently in children of younger age [5], and lower body weight was reported to be a risk factor for these complications [6,7]. Additionally, dysphagia associated with poor pharyngeal muscle weakness is a risk factor for aspiration leading to respiratory complications [8].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report

Saito

Kimura

Hashimoto³

et al. 2018

JA Clin Rep

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Background: We report the case of a child with Krabbe disease who underwent three repeated surgeries and anesthetic management, and we discuss the major concerns about Krabbe disease and the usefulness of a perioperative administration of dexmedetomidine to prevent emergence agitation and hypertension. The patient was scheduled to undergo bilateral orchiopexy, adenotonsillectomy, and knee flexor tendon lengthening under general anesthesia during a 2-year period. Case presentation: Adenotonsillectomy was scheduled as the second operation when the patient was 4 years old. His height and body weight were 93 cm and 10.3 kg, respectively. Anesthesia was induced with 8% sevoflurane mixed with 6 L/min of O 2 and maintained with N 2 O (3.5 L/min), O 2 (1.5 L/min), and sevoflurane (1.5-2.0%). Upon completion of the right tonsillectomy, 1 h before the end of the surgery, a continuous infusion of dexmedetomidine (0.2 μg/kg/h) was started to prevent emergence agitation, irritability, resultant hypertension, and postoperative bleeding. Fentanyl (25 μg) was administered intravenously to reduce postoperative pain. The surgery was uneventful, and the patient's emergence from general anesthesia was prompt. He exhibited no symptoms of emergence agitation or irritability. During his stay in the intensive care unit, 0.2-0.7 μg/kg/h of dexmedetomidine and 6.25 μg/h of fentanyl were continuously administered. The patient was discharged to the ward the following morning without complications. Conclusions: The perioperative administration of dexmedetomidine was useful to prevent emergence agitation, hypertension, and resultant postoperative bleeding in a pediatric patient with Krabbe disease. Three repeated anesthetic management using inhalation anesthesia were completed uneventfully without muscle relaxants.

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“…Regarding complications, a prospective randomized study showed that the risk of overall complications at emergence was increased in children at high risk for respiratory complications when extubated awake (62% vs 20%): This concerned mainly persistent coughing (and an increased risk of getting a hoarse voice) and both short‐ and long‐duration episodes of oxygen desaturation. On the other hand, deep extubation increased the risk of partial airway obstruction (10% vs 4% in the awake group) . A recent observational study with a larger number of patients showed no difference in the incidence of perioperative complications between awake and deep extubation, but the choice and timing of extubation were left to the clinical judgment of the attending anesthesiologist: 66.6% of cases were extubated “deep” (but no clear definition of it was given), and this technique tended to be used more often in children presenting with an upper respiratory tract infection …”

Section: Awake or Deep Extubation?mentioning

confidence: 99%

Tracheal extubation in children: Planning, technique, and complications

Veyckemans

2020

Pediatric Anesthesia

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Although poorly described in textbooks and rarely a topic of lecture, tracheal extubation is a critical phase of anesthetic care. It should therefore be carefully planned taking into account simple physiology‐based principles to maintain the upper airway patent and avoid lung de‐recruitment, but also the pharmacology of all anesthetic agents used. Although the management of most of its complications can be learned in a clinical simulation environment, the basic techniques can so far only be taught at the bedside, in the operating room. In this paper, the process of extubation is described in successive steps: preparation, return to adequate spontaneous ventilation, awake versus deep extubation, timing according to the child's breathing cycle, extubation in the operating room or in the Postanesthesia Care unit, child's management immediately after extubation, diagnosis and treatment of the early complications, and finally, how to prepare for a difficult reintubation.

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Perioperative respiratory complications following awake and deep extubation in children undergoing adenotonsillectomy

Abstract: There was no difference in the incidence of perioperative respiratory complications in children undergoing a T&A following an awake vs deep extubation. Only weight ≤14 kg was associated with increased perioperative respiratory complications.

Cited by 68 publications

References 17 publications

An update on the perioperative management of children with upper respiratory tract infections

An update on the perioperative management of children with upper respiratory tract infections

Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report

Tracheal extubation in children: Planning, technique, and complications

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