The Challenges of Pediatric Anesthesia for Ambulatory Adenotonsillectomy

Purpose of review: With a prevalence of about 10%, pediatric sleep-disordered breathing (PSDB) contributes to significant epidemiological burden. The first line of management is adenotonsillectomy (AT), which restores airflow and leads to resolution of symptoms in over 80% of children. Providing safe and effective administration of general anesthesia in this ‘at risk’ population can be a challenge in the ambulatory setting. Recent findings: Safe and effective administration of general anesthesia as well as pain management in children undergoing AT is contingent upon early recognition of risk factors and choosing the right combination of anesthetic and analgesic medications. The use of opioid-sparing techniques and increased alertness on the part of the practitioner to the potential complications of undiagnosed severe OSA are crucial. Summary: Pediatric sleep-disordered breathing (PSDB) represents a spectrum of disorders that result from varying degrees of upper airway obstruction during sleep. These disorders range from primary snoring (PS), to obstructive sleep apnea (OSA) of varying degrees and all are treated with adenotonsillectomy (AT) which results in resolution of symptoms in vast majority of children. Over half a million tonsillectomies are performed each year in the US (Roland et al. in Otolaryngol Head Neck Surg 145:S1–15, 2011), with most completed in an ambulatory setting without laboratory investigations preceding surgery. Because of the wide spectrum that PSDB encompasses, it is important to be mindful of the varying risks that this population can have in the ambulatory surgery setting.