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The role of oral fluid intake following adeno-tonsillectomy
Abtin Tabaee1, Jerry W Lin, Vanessa Dupiton
1Department of Otolaryngology, Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA.
Insights
Encouraging children to drink fluids after adenotonsillectomy (T&A) did not reduce complications but may increase vomiting. A voluntary approach to oral fluid intake is recommended post-pediatric T&A surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Anesthesiology
Background:
- Post-operative fluid intake is crucial for recovery after pediatric adenotonsillectomy (T&A).
- Current protocols often include a mandatory trial of oral fluids before discharge.
Purpose of the Study:
- To compare post-T&A complication rates between pediatric patients encouraged to drink fluids and those drinking voluntarily.
- To evaluate the impact of a mandatory fluid intake protocol on emesis and dehydration.
Main Methods:
- A prospective, randomized, non-blinded study involving 93 pediatric patients (2-12 years) undergoing ambulatory T&A.
- Patients were divided into two groups: one encouraged to drink 240 ml of clear liquid, the other drinking voluntarily.
- Outcomes assessed included emesis, dehydration, and other complications.
Main Results:
- Patients encouraged to drink were more likely to reach the target fluid volume (50% vs. 31%).
- Higher rates of emesis were observed when the goal volume was reached in both groups.
- No significant differences were found in PACU stay, emesis incidence/volume, or dehydration between groups.
Conclusions:
- A mandatory oral fluid intake trial may not be necessary for pediatric T&A discharge.
- Encouraging mandatory oral fluid intake could potentially increase the incidence of post-operative emesis.
Objective:
To compare the incidence of complications following pediatric adeno-tonsillectomy (T&A) in patients who are encouraged to drink oral liquid versus patients who drink on a voluntary basis.
Methods:
This is a prospective, randomized, non-blinded study performed in a tertiary care medical center. Ninety-three otherwise healthy pediatric patients aged 2-12 years undergoing ambulatory T&A by a single surgeon were included in the study. Forty four patients were encouraged to drink 240 ml of clear liquid prior to discharge while 49 patients drank on a voluntary basis. Patients were followed prospectively for the incidence of emesis, dehydration and other complications.
Results:
Overall, emesis was experienced by 18% of patients in the post anesthesia care unit (PACU) and by 20% at home. Fifty percent of patients in the encouraged group versus 31% in the voluntary group reached the goal volume of oral liquids (p<0.05). The incidence of emesis was higher in both the encouraged (41% versus 14%) and voluntary group (40% versus 26%) when the goal volume of 240 ml was reached. There was no statistically significant difference between the two groups in terms of duration of PACU stay, incidence of emesis, number of episodes of emesis or volume of emesis. Further, there was no difference between the two groups in terms of post-operative complications including dehydration.
Conclusions:
The current practice of a mandatory trial of oral fluid intake in the post-operative period may not be a necessary requirement for discharge. Further, mandatory oral fluids may result in a higher incidence of emesis.
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