Anesthetic outcomes in pediatric tonsillectomy: insights from the Palestinian experience

Despite advancements in anesthesia, the anesthetic outcomes in pediatric tonsillectomy remain largely underexplored, notably in resource-limited healthcare systems. This study aimed to assess the anesthetic outcomes in pediatric tonsillectomy, including induction-to-incision time and predictors of duration of surgery.

The study was conducted at one of the major surgical hospitals in the West Bank of Palestine, which is a tertiary referral center known for its comprehensive surgical and anesthetic services. The data were collected retrospectively from pediatric patients who underwent tonsillectomy with or without adenoidectomy in the period between 2021 and 2022. The data were collected using a standardized data collection form.

Of the 238 pediatric patients included in this study, 231 (97.1%) were operated for adenotonsillar hypertrophy, and 7 (2.9%) were operated for recurrent/chronic tonsillitis. The mean age of the patients was 5.6 ± 3.1 years. Of the patients, 151 (63.4%) were male, 13 (5.5%) had an allergy to foods or drugs 13 (5.5%) had other comorbidities, and 21 (8.8%) had a past surgical history. Of the patients, 230 (96.6%) received propofol and 183 (76.9%) received fentanyl as anesthesia induction agents. The mean induction to incision time was 5.2 ± 1.1 min, and the mean duration of surgery was 26.4 ± 5.4 min. Of the patients, 53 (22.3%) received antibiotics during surgery. The induction to incision time was significantly longer for male patients (5.4 ± 1.3 vs. 5.0 ± 0.7, p-value = 0.022). The duration of surgery was significantly longer for female patients, 5 years and older, who had allergies, had chronic tonsillitis, and received antibiotics during the surgery. Multiple linear regression showed that longer duration of surgery could be predicted by being operated for recurrent/chronic tonsillitis (β = 0.15) and receiving antibiotics during the surgery (β = 0.13).

The findings of this study revealed that patient-specific factors influenced induction-to-incision time and duration of surgery. The findings of this study highlight the need for tailored preoperative assessment and individualized perioperative management to optimize resource utilization and improve surgical efficiency in resource-limited settings.