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Force Metrics During the Boyle-Davis Gag in Children Undergoing Adenotonsillectomy

Enriqueta Arevalo Asensio1, Anelise Schifino Wolmeister1, Thomas Engelhardt1,2

  • 1Division of Pediatric Anesthesia, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC H4A 3J1, Canada.

Children (Basel, Switzerland)
|March 28, 2026
PubMed

Insights

Pediatric adenotonsillectomy force metrics did not correlate with opioid use or delirium. However, increased suspension time showed a weak negative correlation with postoperative pain in children.

Area of Science:

  • Pediatric Anesthesiology
  • Surgical Outcomes Research
  • Pain Management in Children

Background:

  • Boyle-Davis Gag suspension forces correlate with postoperative pain in adults, but pediatric data are lacking.
  • Investigating intraoperative force metrics and their association with pediatric postoperative outcomes is crucial.

Purpose of the Study:

  • To examine the relationship between intraoperative force metrics during adenotonsillectomy/adenoidectomy and postoperative outcomes in children.
  • To assess correlations between force metrics, opioid consumption, pain, emergence delirium (ED), and hypoactive delirium.

Main Methods:

  • Prospective study of children undergoing elective adenotonsillectomy or adenoidectomy.
  • Measurement of intraoperative maximum/average forces, suspension time, and total impulse.
  • Assessment of postoperative opioid consumption, pain scores, ED, and hypoactive delirium.

Main Results:

  • Force metrics showed no association with postoperative opioid consumption, ED, or hypoactive delirium.
  • Total impulse decreased with increasing pain severity.
  • Suspension time was negatively correlated with postoperative pain scores (r = -0.32, p = 0.041).

Conclusions:

  • Intraoperative force metrics during pediatric adenotonsillectomy/adenoidectomy are generally low.
  • Force metrics do not predict opioid consumption, emergence delirium, or hypoactive delirium in children.
  • Suspension time exhibits a weak correlation with postoperative pain, suggesting a potential, albeit minor, link.

Keywords:
force metricsforce sensorgag suspensionoropharyngeal suspensionpediatric patientspostoperative emergence deliriumpostoperative pain

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