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Anesth Analg 2007; 105:1512-1513
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000287014.83970.bf
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LETTER TO THE EDITOR

Factors Influencing Postanesthesia Recovery After Pediatric Ambulatory Tonsillectomy and Adenoidectomy

Mary H. Lane, FRCA, Fidelma Flynn, FCARCSI, Lucy H. Hepburn, FRCA, and Sian Jaggar, FRCA

Department of Anaesthesia; Royal Brompton Hospital; London, UK; mary{at}marylane.fsnet.co.uk

To the Editor:

We welcome the perceptive study by Edler et al. (1) who present some potentially useful findings. However, because pain after tonsillectomy and adenoidectomy is known to be considerable (2) and a common cause of prolonged length of stay (3,4), we were surprised that no data regarding pain were included. We believe the model would appear vastly different had this been included, and suspect that the model's predictive value is severely limited by this absence.

The leading cause of prolonged length of stay and unplanned admissions is postoperative nausea and vomiting (3,5,6), a well-known complication of tonsillectomy and adenoidectomy (7). The combination of ondansetron and dexamethasone has recently been shown to be more effective in preventing postoperative nausea and vomiting than is a single agent (8,9). It is unclear therefore why the authors enrolled their subjects in a second study allowing them only a single antiemetic agent, which would clearly influence results regarding length of stay.

Despite these reservations, we encourage further population-based studies of this nature to elucidate both best clinical practice and more cost-effective management plans.

REFERENCES

  1. Edler AA, Mariano ER, Golianu B, Kuan C, Pentcheva K. An analysis of factors influencing postanesthesia recovery after pediatric ambulatory tonsillectomy and adenoidectomy. Anesth Analg 2007;104:784–9[Abstract/Free Full Text]
  2. Warnock FF, Lander J. Pain progression, intensity and outcomes following tonsillectomy. Pain 1998;75:37–45[Web of Science][Medline]
  3. Brown PM, Fowler S, Ryan R, Rivron R. ENT day surgery in England and Wales. An audit by the Royal College of Surgeons (Eng.) Comparative Audit Service. J Laryngol Otol 1998;112:161–5[Web of Science][Medline]
  4. Awad IT, Moore M, Rushe C, Elburki A, O'Brien K, Warde D. Unplanned hospital admission in children undergoing day-case surgery. Eur J Anaesthesiol 2004;21:379–83[Web of Science][Medline]
  5. D'Errico C. Prolonged recovery stay and unplanned admission of the pediatric surgical outpatient: an observational study. J Clin Anesth 1998;10:482–7[Web of Science][Medline]
  6. Patel RI, Hannallah RS. Anesthetic complications following pediatric ambulatory surgery: a 3-yr study. Anesthesiology 1988;69:1009–12[Web of Science][Medline]
  7. Ved SA, Walden TL, Montana J, Lea DE, Tefft MC, Kataria BK, Pudimat MA, Nicodemus HF, Milmoe GJ. Vomiting and recovery after outpatient tonsillectomy and adenoidectomy in children. Comparison of four anesthetic techniques using nitrous oxide with halothane or propofol. Anesthesiology 1996;85:4–10[Web of Science][Medline]
  8. Splinter WM. Prevention of vomiting after strabismus surgery in children: dexamethasone alone versus dexamethasone plus low-dose ondansetron. Paediatr Anesth 2001;11:591–5
  9. Steward DL, Welge JA, Myer CM. Steroids for improving recovery following tonsillectomy in children. Cochrane Database Syst Rev 2003;CD003977




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2007 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press