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PEDIATRIC ANESTHESIA

An Analysis of Factors Influencing Postanesthesia Recovery After Pediatric Ambulatory Tonsillectomy and Adenoidectomy

Alice A. Edler, MD, MPH, MA^*, Edward R. Mariano, MD, Brenda Golianu, MD^*, Calvin Kuan, MD^*, and Krassimira Pentcheva, MD^*

From the *Department of Anesthesia, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California; and Department of Anesthesia, San Diego School of Medicine, University of California, San Diego, California.

Address correspondence and reprint requests to: Alice Edler, MD, Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive H3580, Stanford, CA 94305. Address e-mail to edlera{at}aol.com.

BACKGROUND: Many factors contribute to prolonged length of stay (LOS) for pediatric patients in the postanesthesia care unit (PACU). We designed this prospective study to identify the pre- and postoperative factors that prolong LOS.

METHODS: We studied 166 children, aged 1–18 yr, who underwent tonsillectomy and adenoidectomy or tonsillectomy and adenoidectomy, and bilateral myringotomy with tube insertion under general anesthesia. The primary outcome measure was the time spent in the PACU until predetermined discharge criteria were met.

RESULTS: The number of episodes of postoperative nausea and vomiting, patient age, and number of oxygen desaturations contributed significantly (P < 0.05) to prolonged LOS. Each episode of postoperative nausea and vomiting (P < 0.05) or oxygen desaturation to <95% (P < 0.05) increased the patient's LOS by 0.5 h. History of upper respiratory tract infection, emergence agitation, and parental anxiety did not significantly predict increased LOS.

CONCLUSION: This investigation is the first composite view of LOS in pediatric patients. The significance of identifying patients at risk of prolonged LOS prior to anesthesia is of use not only in allocating PACU resource and staffing needs, but also for improving quality of care and ensuring a minimally traumatic anesthetic experience for our pediatric patients and their families.

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