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Adenotonsillectomy in the morbidly obese child
Andrew Spector1, Sara Scheid, Sandra Hassink
1Department of Otolaryngology, Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19134, USA.
International Journal of Pediatric Otorhinolaryngology
|March 29, 2003
Summary
Routine pediatric intensive care unit admission is not necessary for most morbidly obese children after adenotonsillectomy. While some required interventions, these can be managed on a surgical floor, suggesting the procedure is not as risky as believed.
Area of Science:
- Pediatric Surgery
- Obesity Medicine
- Anesthesiology
Background:
- Pediatric obesity prevalence has significantly increased, leading to more surgical procedures in this population.
- Adenotonsillectomy (AT) is a common pediatric surgical procedure.
- The safety and complication rates of AT in morbidly obese (MO) children require further investigation.
Purpose of the Study:
- To determine the complication rate in MO children undergoing AT.
- To assess the necessity of elective pediatric intensive care unit (PICU) admission for observation in MO children post-AT.
Main Methods:
- Retrospective study of postoperative PICU admissions over 4 years.
- Analysis of 14 MO children (BMI >95th percentile) who underwent AT for obstructive sleep apnea.
- Outcomes were determined based on postoperative complications and interventions.
Main Results:
- Two patients required bi-level positive airway pressure (BiPAP) for desaturation.
- One patient required prolonged intubation (10 days).
- Three patients needed supplemental oxygen; interventions were manageable on a surgical floor.
Conclusions:
- Routine PICU admission is not warranted for most MO children undergoing AT.
- Interventions required by some MO patients can be managed in a surgical floor bed.
- Further prospective studies using preoperative polysomnograms are recommended to identify indicators for PICU admission.