[Hypoxaemia during non-intubated adenotonsillectomy; more common in sitting or supine position?]

To investigate the incidence of hypoxaemia, bradycardia and post-operative bleeding in non-intubated Sluder method adenotonsillectomy patients in sitting versus supine position.

Explorative study.

A retrospective database was drawn up with data from all patients on whom a Sluder method non-intubated adenotonsillectomy was performed in a Dutch district general hospital between 01 January 2012 and 01 May 2018. Depending on the preference of the surgeon and following discussion with the anaesthesiologist, the operation was performed with the patient in either a sitting or supine position. The primary outcome measure was hypoxaemia, defined as SpO2 < 85% for ≥ 60 seconds. Secondary outcome measures included bradycardia and post-operative bleeding.

We analysed the data of 723 adenotonsillectomy patients (46% female, average age 4.5 years), of whom 193 (27%) in sitting and 530 (73%) in supine position. Hypoxaemia occurred in 13 (7%) 'sitting' cohort patients and in 13 (2%) of the supine cohort patients (p = 0.011). No perioperative complications developed as a result of the hypoxaemia. The frequency of bradycardia did not differ between the two cohorts (4 vs 2%; p = 0.442). None of the patients developed both hypoxaemia and bradycardia. In 8 (1%) patients, a secondary intervention was required due to the occurrence of post-operative haemorrhage.

Patients who undergo non-intubated Sluder guillotine method adenotonsillectomy when in a sitting position are more likely to develop hypoxaemia than those who are operated on in a supine position. In order to make an informed recommendation, a randomized trial is indicated.