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Perioperative clinical practice recommendations for pediatric tonsillectomy: a systematic review

Alfonso E Albornoz1,2, Mehwish Rana3, Jason Hayes1,2

  • 1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|January 5, 2024
PubMed

Insights

This systematic review analyzed clinical practice guidelines for pediatric tonsillectomy perioperative care. Acetaminophen, NSAIDs, and steroids are recommended for pain management in children undergoing tonsillectomy.

Area of Science:

  • Pediatric Surgery
  • Anesthesiology
  • Evidence-Based Medicine

Background:

  • Tonsillectomy is a common pediatric surgical procedure.
  • Existing clinical practice guidelines (CPGs) primarily focus on surgical decisions, not perioperative management.
  • There is a need for CPGs specifically addressing the perioperative care of children undergoing tonsillectomy.

Approach:

  • A systematic review was conducted to identify and analyze existing CPGs for pediatric tonsillectomy perioperative management.
  • Searches were performed in Embase, MEDLINE, MEDLINE ePub Ahead of Print, and CINAHL up to August 3, 2022.
  • Inclusion criteria focused on CPGs with evidence-based recommendations for tonsillectomy under general anesthesia in children, published in English after 2000.

Key Points:

  • Five eligible CPGs were identified; two were rated high quality.
  • Most recommendations focused on pain management, with acetaminophen being universally recommended.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids were supported as adjuncts in most CPGs.

Conclusions:

  • Acetaminophen, NSAIDs, and steroids are recommended for perioperative management of pediatric tonsillectomy.
  • Future CPGs should address safe opioid use, considering obstructive sleep apnea severity and opioid-sparing techniques.
  • Further clarification is needed on adjuncts like dexmedetomidine, high-dose dexamethasone, and gabapentinoids.
Abstract

Keywords:
clinical practice guidelinesgeneral anesthesiapediatric tonsillectomyperioperative caresystematic review

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