How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy

Christopher Roberts, Raihanah Al Sayegh, Pavithra Ranganathan Ellison, Khaled Sedeek, Michele M. Carr

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). Study Design: Online survey. Method: A sample of pediatric anesthesiologists received the survey by email. Results: 110 respondents were included. 46.4% worked in a free-standing children’s hospital and 32.7% worked in a children’s facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children’s hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). Conclusion: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalAnnals of Otology, Rhinology and Laryngology
Volume129
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Tonsillectomy
Obstructive Sleep Apnea
Pediatrics
Ondansetron
Dexamethasone
Guidelines
Anesthesiologists
Premedication
Practice Management
Midazolam
Narcotics
Nitrous Oxide
Fentanyl
Non-Steroidal Anti-Inflammatory Agents
Acetaminophen
Visual Analog Scale
Practice Guidelines
General Hospitals
Morphine
Anesthesia

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

Roberts, Christopher ; Al Sayegh, Raihanah ; Ellison, Pavithra Ranganathan ; Sedeek, Khaled ; Carr, Michele M. / How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy. In: Annals of Otology, Rhinology and Laryngology. 2020 ; Vol. 129, No. 1. pp. 55-62.
@article{ac7af854166e47c6b33253ecbf14db99,
title = "How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy",
abstract = "Objective: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). Study Design: Online survey. Method: A sample of pediatric anesthesiologists received the survey by email. Results: 110 respondents were included. 46.4{\%} worked in a free-standing children’s hospital and 32.7{\%} worked in a children’s facility within a general hospital. 73.6{\%} taught residents. 44.4{\%} saw at least one child with OSA per week, 25.5{\%} saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6{\%} gave oral midazolam preoperatively, but 24.5{\%} typically withheld premedication and had the parent present for induction. 68.2{\%} would typically use nitrous oxide for inhalational induction. 68.2{\%} used fentanyl intraoperatively, while 20.0{\%} used morphine. 61.5{\%} reduced their intraop narcotic dose for children with OSA. 98.2{\%} used intraoperative dexamethasone, 58.2{\%} used 0.5 mg/kg for the dose. 98.2{\%} used ondansetron, 62.7{\%} used IV acetaminophen, and 8.2{\%} used IV NSAIDs. 83.6{\%} extubated awake. 27.3{\%} of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children’s hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). Conclusion: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.",
author = "Christopher Roberts and {Al Sayegh}, Raihanah and Ellison, {Pavithra Ranganathan} and Khaled Sedeek and Carr, {Michele M.}",
year = "2020",
month = "1",
day = "1",
doi = "10.1177/0003489419874371",
language = "English (US)",
volume = "129",
pages = "55--62",
journal = "Annals of Otology, Rhinology and Laryngology",
issn = "0003-4894",
publisher = "Annals Publishing Company",
number = "1",

}

How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy. / Roberts, Christopher; Al Sayegh, Raihanah; Ellison, Pavithra Ranganathan; Sedeek, Khaled; Carr, Michele M.

In: Annals of Otology, Rhinology and Laryngology, Vol. 129, No. 1, 01.01.2020, p. 55-62.

Research output: Contribution to journalArticle

TY - JOUR

T1 - How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy

AU - Roberts, Christopher

AU - Al Sayegh, Raihanah

AU - Ellison, Pavithra Ranganathan

AU - Sedeek, Khaled

AU - Carr, Michele M.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objective: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). Study Design: Online survey. Method: A sample of pediatric anesthesiologists received the survey by email. Results: 110 respondents were included. 46.4% worked in a free-standing children’s hospital and 32.7% worked in a children’s facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children’s hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). Conclusion: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.

AB - Objective: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). Study Design: Online survey. Method: A sample of pediatric anesthesiologists received the survey by email. Results: 110 respondents were included. 46.4% worked in a free-standing children’s hospital and 32.7% worked in a children’s facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children’s hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). Conclusion: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.

UR - http://www.scopus.com/inward/record.url?scp=85073776111&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073776111&partnerID=8YFLogxK

U2 - 10.1177/0003489419874371

DO - 10.1177/0003489419874371

M3 - Article

AN - SCOPUS:85073776111

VL - 129

SP - 55

EP - 62

JO - Annals of Otology, Rhinology and Laryngology

JF - Annals of Otology, Rhinology and Laryngology

SN - 0003-4894

IS - 1

ER -