Post-operative nausea and vomiting following paediatric day-case tonsillectomy: audit of the Epsom protocol

Robb, Peter; Ewah, B.

doi:10.1017/s0022215111001435

Cited by 14 publications

(16 citation statements)

References 18 publications

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“…This is similar to the literature, in which about 1.3% of patients experience delayed discharge during the initial hospital stay, and up to 3.9% have secondary complications requiring admission 8 . The incidence of non-respiratory complications (dehydration 4.5%, hemorrhage 2.3% and fever 0.5%) was also similar to that reported from other studies 25 . However, the rate of post-operative respiratory complications was lower (1.4%) than the range of 5–23% reported in the literature 26–28 .…”

Section: Discussionsupporting

confidence: 89%

Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children

Konstantinopoulou

Gallagher

Elden

et al. 2015

International Journal of Pediatric Otorhinolaryngology

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Introduction Adenotonsillectomy is the treatment of choice for most children with obstructive sleep apnea syndrome, but can lead to complications. Current guidelines recommend that high-risk children be hospitalized after adenotonsillectomy, but it is unclear which otherwise-healthy children will develop post-operative complications. We hypothesized that polysomnographic parameters would predict post-operative complications in children who participated in the Childhood AdenoTonsillectomy (CHAT) study. Methods Children in the CHAT study aged 5–9 years with apnea hypopnea index 2–30/hr or obstructive apnea index 1–20/hr without comorbidities other than obesity/asthma underwent adenotonsillectomy. Associations between demographic variables and surgical complications were examined with Chi square and Fisher’s exact tests. Polysomnographic parameters between subjects with/without complications were compared using Mann-Whitney tests. Results Of the 221 children (median apnea hypopnea index 4.7/hr, range 1.2–27.7/hr; 31% obese), 16 (7%) children experienced complications. 3 (1.4%) children had respiratory complications including pulmonary edema, hypoxemia and bronchospasm. Thirteen (5.9%) had non-respiratory complications, including dehydration (4.5%), hemorrhage (2.3%) and fever (0.5%). There were no statistically significant associations between demographic parameters (gender, race, and obesity) or polysomnographic parameters (apnea hypopnea index, % total sleep time with SpO2<92%, SpO2 nadir, % sleep time with end-tidal CO2>50 Torr) and complications. Conclusions This study showed a low risk of post-adenotonsillectomy complications in school-aged healthy children with obstructive apnea although many children met published criteria for admission due to obesity, or polysomnographic severity. In this specific population, none of the polysomnographic or demographic parameters predicted post-operative complications. Further research could identify the patients at greatest risk of post-operative complications.

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Section: Discussionsupporting

confidence: 89%

Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children

Konstantinopoulou

Gallagher

Elden

et al. 2015

International Journal of Pediatric Otorhinolaryngology

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“…Postoperative nausea and vomiting after tonsillectomy is a complication that, along with postoperative pain, can significantly compromise the patient's quality of life. Many studies have shown that drugs such as ondansetron, palonosetron, metoclopramide, dexamethasone, and midazolam can reduce PONV . However, the exact mechanism of action of midazolam and dexamethasone is unknown.…”

Section: Discussionmentioning

confidence: 99%

The effect of acupuncture on postoperative nausea and vomiting after pediatric tonsillectomy: A meta‐analysis and systematic review

et al. 2016

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“…However, we found no significant association between PSG parameters and nonrespiratory complications, and the incidence of nonrespiratory complications was similar to those from other studies. 8,9,29 …”

Section: Discussionmentioning

confidence: 99%

Predictors of Perioperative Complications in Higher Risk Children after Adenotonsillectomy for Obstructive Sleep Apnea: A Prospective Study

Thongyam

Marcus

Lockman

et al. 2014

Otolaryngol.--head neck surg.

179

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Objective Retrospective studies have limitations in predicting perioperative risk following adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS). Few prospective studies exist. We hypothesized that demographic and polysomnographic (PSG) variables would predict respiratory and general perioperative complications. Study Design Prospective, observational cohort study. Setting Pediatric tertiary center. Subjects and Methods Consecutive children undergoing adenotonsillectomy for OSAS within 12 months of PSG were evaluated for complications occurring within 2 weeks of surgery. Results There were 329 subjects, with 27% <3 years old, 24% obese, 16% preterm, and 29% with comorbidities. In this higher risk population, 28% had respiratory complications (major and/or minor), and 33% had nonrespiratory complications. Significant associations were found between PSG parameters and respiratory complications as follows: apnea hypopnea index (rank-biserial correlation coefficient [r] = 0.174, P = .017), SpO2 nadir (r = –0.332, P <.0005), sleep time with SpO2 <90% (r = 0.298, P <.0005), peak end-tidal CO2 (r = 0.354, P <.0005), and sleep time with end-tidal CO2 >50 mm Hg (r = 0.199, P = .006). Associations were also found between respiratory complications and age <3 years (r = –0.174, P = .003) or black race (r = 0.123, P = .039). No significant associations existed between PSG parameters and nonrespiratory complications. A model using age <3 years, SpO2 nadir, and peak CO2 predicted respiratory complications better than the American Academy of Pediatrics or American Academy of Otolaryngology—Head and Neck Surgery Foundation guidelines but was imperfect (area under the curve = 0.72). Conclusion Thus, PSG predicted perioperative respiratory, but not nonrespiratory, complications in children with OSAS. Age <3 years or black race are high-risk factors. Present guidelines have limitations in determining the need for postoperative admission.

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Post-operative nausea and vomiting following paediatric day-case tonsillectomy: audit of the Epsom protocol

Abstract: These findings have implications for the safe same-day discharge of children following tonsillectomy.

Cited by 14 publications

References 18 publications

Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children

Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children

The effect of acupuncture on postoperative nausea and vomiting after pediatric tonsillectomy: A meta‐analysis and systematic review

Predictors of Perioperative Complications in Higher Risk Children after Adenotonsillectomy for Obstructive Sleep Apnea: A Prospective Study

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