Related Experiment Video
Updated: Jan 6, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Respiratory complications after adenotonsillectomy in high-risk children with obstructive sleep apnea: A
Margaret Ekstein1, Lilach Zac1, Reut Schvartz1
1Division of Anesthesiology, Intensive Care, and Pain Medicine, Sackler Faculty of Medicine, Tel-Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel.
Insights
Adverse respiratory events after adenotonsillectomy in children can occur in the pediatric intensive care unit (PICU) even without prior events in the post-anesthesia care unit (PACU). This highlights the need for continued vigilance in high-risk pediatric patients.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Respiratory Medicine
Background:
- Obstructive sleep apnea (OSA) affects 1%-4% of children, with adenotonsillectomy being a common treatment.
- While generally safe, adenotonsillectomy carries a small risk of mortality or severe brain injury, often due to respiratory complications.
- Children under 2 years, those with extreme weight, or with craniofacial, neuromuscular, cardiac, or severe OSA are at higher risk for adverse post-operative respiratory events (AEs).
Purpose of the Study:
- To identify risk factors associated with adverse respiratory events (AEs) in the post-anesthesia care unit (PACU), pediatric intensive care unit (PICU), or both following adenotonsillectomy in children.
- To investigate factors predicting PICU AEs in children who did not experience events in the PACU, to better predict the need for post-operative PICU admission.
Main Methods:
- A retrospective study analyzed data from children admitted to the PICU after adenotonsillectomy between August 2006 and September 2015.
- Data collected included demographics, risk factors, and the occurrence of specific AEs such as oxygen saturation below 92%, stridor, bronchospasm, pneumonia, pulmonary edema, and re-intubation.
- 179 children who met the criteria were included in the analysis.
Main Results:
- Of 3997 children undergoing adenotonsillectomy, 179 were admitted to the PICU. Adverse events occurred in 59% of these PICU admissions.
- 42% of children experienced AEs in the PACU. Of those with PACU events, 92% subsequently had AEs in the PICU.
- Importantly, 35% of children who did not have PACU AEs still experienced AEs in the PICU.
Conclusions:
- In high-risk children undergoing adenotonsillectomy, the absence of adverse events in the PACU during a 2-hour observation period does not reliably predict the absence of subsequent AEs in the PICU.
- Continuous monitoring and risk assessment are crucial for pediatric patients post-adenotonsillectomy, particularly those with identified risk factors.
Background:
Obstructive sleep apnea (OSA) occurs in 1%-4% of children; adenotonsillectomy is an effective treatment. Mortality/severe brain injury occurs among 0.6/10 000 adenotonsillectomies; in children, 60% are secondary to airway/respiratory events. Earlier studies identified that children aged <2 years, extremes of weight, with co-morbidities of craniofacial, neuromuscular, cardiac/respiratory disease, or severe OSA are at high risk for adverse post-operative respiratory events (AE). We aimed to: Firstly, investigate which risk factors were associated with AEs either in the post-anesthesia care unit (PACU), pediatric intensive care unit (PICU), or both in this population. Secondly, we investigated factors associated with post-operative PICU AE despite no event in the PACU in order to predict need of post-operative PICU after their PACU stay.
Methods:
Retrospective study of children admitted to the PICU after adenotonsillectomy between 08/2006-09/2015. Demographics, risk factors, and occurrence of AE (oxygen saturation <92, stridor, bronchospasm, pneumonia, pulmonary edema, re-intubation) were recorded.
Results:
During the studied time period 4029 tonsil/adenoid procedures were performed in 3997 children. 179, admitted to the PICU post-operatively, met criteria for analysis. PICU AEs occurred in 59%: 44%-83% in any particular risk category. PACU AEs occurred in 42%. Of those with PACU events: 92% suffered AEs in the PICU; however, 35% of those without a PACU AE still suffered a PICU AE.
Conclusions:
Among high-risk children undergoing TA, absence of adverse events in PACU during a 2-hour observation period does not predict absence of subsequent AEs in the PICU.
Related Concept Videos
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:21Sleep Apnea
The condition is more prevalent among...
01:23Acute Respiratory Failure-IV
01:17Other Pulmonary Disorders
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....