Paediatric adenotonsillectomy, part 1: surgical perspectives relevant to the anaesthetist.

  • Obstructive sleep disordered breathing (oSDB) and the obstructive sleep apnoea (OSA) syndrome are different. OSA syndrome is the most severe form of oSDB and is associated with end organ dysfunction. Adenotonsillectomy (AT) is performed to arrest or reverse this end organ dysfunction.
  • Polysomnography (PSG) is the gold standard for diagnosis of OSA but history and overnight pulse oximetry may be used for diagnosis.
  • The paediatric pharyngeal airway is smaller in diameter with a higher muscular tone meaning obstructive apnoeas are less common and the AHI has therefore lower thresholds in children. Airway collapse occurs at a lower more negative critical closing pressure.
  • Recurrent tonsillitis is an indication for surgery but there is no agreed consensus on the number or type of infections. In addition, there remains limited evidence to suggest that tonsillectomy for recurrent infections improves quality of life.
  • Surgical approaches may include extracapsular tonsillectomy and partial tonsillectomy with comparable efficacy for OSA treatment. No surgical technique has been found to be consistently superior in terms of postoperative pain, bleeding and wound healing.
  • AT has been shown to normalise sleep studies in 80% of children postoperatively. Long term benefits remain unclear.

Reviewed by Dr. Katherine Lanigan