Preferred Anesthesia for Routine Otolaryngologic Procedures

  • Monica Shah
  • Mofya S. Diallo


Tympanostomy tube placement, adenotonsillectomy, and cochlear implant placement are common otolaryngologic procedures performed on children everyday around the world. Young children are more likely to develop chronic otitis media due to their immaturely developed eustachian tubes. Myringotomy and tympanostomy tube placement helps to decrease their risk of further developing otitis media and hearing loss. This procedure is very brief but requires children to lie very still; therefore, general anesthesia is usually necessary. Adenotonsillectomies are usually necessitated for the treatment of recurrent tonsillitis or obstructive symptoms. Obstructive sleep apnea predisposes these children to increased perioperative risks with general anesthesia, and many of these patients should be monitored overnight postoperatively.


Tympanostomy Emergence delirium Same-day surgery Obstructive sleep apnea Adenotonsillectomy Cochlear implant 


  1. 1.
    Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Rep. 2009;11:1–25.Google Scholar
  2. 2.
    Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngol Head Neck Surg. 2013;149:S1.PubMedCrossRefGoogle Scholar
  3. 3.
    Olutoye O. Chapter 17: Anesthesia for ear, nose and throat (ENT) surgery. In: Gregory GA, Andropoulos DB, editors. Anesthesia care of pediatric patients in developing countries; 2015. p. 469–86.Google Scholar
  4. 4.
    Hannallah RS, Brown K, Verghese ST. Chapter 31: Otorhinolaryngologic procedures. In: Cote CJ, Lerman J, Anderson BJ, editors. A practice of anesthesia for infants and children. 5th ed. Philadelphia, PA: Saunders/Elsevier; 2013. p. 653–82.Google Scholar
  5. 5.
    Bluestone CD, Paradise JL, Beery QC. Physiology of the eustachian tube in the pathogenesis and management of middle ear effusions. Laryngoscope. 1972;82:1654.PubMedCrossRefGoogle Scholar
  6. 6.
    Berger G. Nature of spontaneous tympanic membrane perforation in acute otitis media in children. J Laryngol Otol. 1989;103:1150.PubMedCrossRefGoogle Scholar
  7. 7.
    Armstrong BW. A new treatment for chronic secretory otitis media. AMA Arch Otolaryngol. 1954;59:653.PubMedCrossRefGoogle Scholar
  8. 8.
    Mandel EM, Swarts JD, Casselbrant ML, Tekely KK, Richert BC, Seroky JT, et al. Eustachian tube function as a predictor of the recurrence of middle ear effusion in children. Laryngoscope. 2013;123:2285.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    von Schoenberg M, Wengraf CL, Gleeson M. Results of middle ear ventilation with Goode's tubes. Clin Otolaryngol Allied Sci. 1989;14:503.CrossRefGoogle Scholar
  10. 10.
    Lentsch EJ, Goudy S, Ganzel TM, Goldman JL, Nissen AJ. Rate of persistent perforation after elective tympanostomy tube removal in pediatric patients. Int J Pediatr Otorhinolaryngol. 2000;54:143.PubMedCrossRefGoogle Scholar
  11. 11.
    Sarasoja I, Jokinen J, Lahdenkari M, Kilpi T, Palmu AA. Long-term effect of pneumococcal conjugate vaccines on tympanostomy tube placements. Pediatr Infect Dis J. 2013;32:517.PubMedCrossRefGoogle Scholar
  12. 12.
    Wilson G, Engelhardt T. Who needs an IV? Retrospective service analysis in a tertiary pediatric hospital. Paediatr Anaesth. 2012;22:442–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Tait AR, Knight PR. The effects of general anesthesia on upper respiratory tract infections in children. Anesthesiology. 1987;67:930–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Tait AR, Pandit UA, Voepel-Lewis T, Munro HM, Malviya S. Use of the laryngeal mask airway in children with upper respiratory tract infections: a comparison with endotracheal intubation. Anesth Analg. 1998;86:706–11.PubMedCrossRefGoogle Scholar
  15. 15.
    Korpela R, Korvenoja P, Meretoja OA. Morphine-sparing effect of acetaminophen in pediatric day-case surgery. Anesthesiology. 1999;91:442–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Birmingham PK, Tobin MJ, Henthorn TK, Fisher DM, Berkelhamer MC, Smith FA, Fanta KB, Cote CJ. 24 hour pharmacokinetics of rectal acetaminophen in children: an old drug with new recommendations. Anesthesiology. 1997;87:244–52.PubMedCrossRefGoogle Scholar
  17. 17.
    Birmingham PK, Tobin MJ, Fisher DM, Henthorn TK, Hall SC, Cote CJ. Initial and subsequent dosing of rectal acetaminophen in children: a 24-hour pharmacokinetic study of new dose recommendations. Anesthesiology. 2001;94:385–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Rampersad S, Jimenez N, Bradford H, Seidel K, Lynn A. Two-agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery. Paediatr Anaesth. 2010;20:1028–35.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Anderson BJ, Woollard GA, Holford NH. Pharmacokinetics of rectal paracetamol after major surgery in children. Paediatr Anaesth. 1995;5:237–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Anderson BJ, Holford NH, Woollard GA, Kanagasundaram S, Mahadevan M. Perioperative pharmacodynamics of acetaminophen analgesia in children. Anesthesiology. 1999;90:411–21.PubMedCrossRefGoogle Scholar
  21. 21.
    Anderson BJ, Rees SG, Liley A, Steward AW, Wardill MJ. Effect of preoperative paracetamol on gastric volumes and pH in children. Paediatr Anaesth. 1999;9:203–7.PubMedGoogle Scholar
  22. 22.
    Anderson BJ, van Lingen RA, Hansen TG, Lin YC, Holford NH. Acetaminophen developmental pharmacokinetics in premature neonates and infants: a pooled population analysis. Anesthesiology. 2002;96:1336–45.PubMedCrossRefGoogle Scholar
  23. 23.
    Finkel JC, Cohen IT, Hannallah RS, Patel KM, Kim MS, Hummer KA, Choi SS, Pena M, Schreiber SB, Zalzal G. The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement. Anesth Analg. 2001;92:1164–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Galinkin JL, Fazi LM, Cuy RM, Chiavacci RM, Kurth CD, Shah UK, Jacobs IN, Watcha MF. Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia. Anesthesiology. 2000;93:1378–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Davis PJ, Greenberg JA, Gendelman M, Fertal K. Recovery characteristics of sevoflurane and halothane in preschool-aged children undergoing bilateral myringotomy and pressure equalization tube insertion. Anesth Analg. 1999;88:34–8.PubMedGoogle Scholar
  26. 26.
    Bennie RE, Boehringer LA, Dierdorf SF, Hannah MP, Means LJ. Transnasal butorphanol is effective for postoperative pain relief in children undergoing myringotomy. Anesthesiology. 1998;89:385–90.PubMedCrossRefGoogle Scholar
  27. 27.
    Pestieau SR, Quezado ZM, Johnson YJ, Anderson JL, Cheng YI, McCarter RJ, Pena MT, Finkel JC. The effect of dexmedetomidine during myringotomy and pressure-equalizing tube placement in children. Paediatr Anaesth. 2011;21:1128–35.PubMedCrossRefGoogle Scholar
  28. 28.
    Bowen L, Thomas M. Pediatric day case surgery. Anesth Intensive Care Med. 2016;17(6):274–9.CrossRefGoogle Scholar
  29. 29.
    Jimenez N, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. An update on pediatric anesthesia liability: a closed claims analysis. Anesth Analg. 2007;104(1):147–53.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Brennan LJ, Atul PJ. Pediatric day-case anesthesia. Contin Educ Anaesth Crit Care Pain. 2003;3:134–8.CrossRefGoogle Scholar
  31. 31.
    August DA, Everett LL. Pediatric ambulatory anesthesia. Anesthesiol Clin. 2014;32:411–29.PubMedCrossRefGoogle Scholar
  32. 32.
    Tait AR, Malviya S. Anesthesia for the child with an upper respiratory tract infection: still a dilemma? Anesth Analg. 2005;100:59–65.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Tait AR, Voepel-Lewis T, Burke C, Kostrzewa A, Lewis I. Incidence and risk factors for perioperative adverse respiratory events in children who are obese. Anesthesiology. 2008;108(3):375–80.PubMedCrossRefGoogle Scholar
  34. 34.
    Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, et al. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;145:S1–S15.PubMedCrossRefGoogle Scholar
  35. 35.
    Brown KA, Laferriere A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology. 2006;105:665–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Viitanen H, Annila P, Viitanen M, Pekka T. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg. 1999;89:75–9.PubMedGoogle Scholar
  37. 37.
    Fortier MA, Kain ZN. Treating perioperative anxiety and pain in children: a tailored and innovative approach. Paediatr Anaesth. 2015;25:27–35.PubMedCrossRefGoogle Scholar
  38. 38.
    Manyande A, Cyna AM, Yip P, Chooi C, Middleton P. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev. 2015;14(7).Google Scholar
  39. 39.
    Vagnoli L, Caprilli S, Messeri A. Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option? Paediatr Anaesth. 2010;20:937–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Mifflin KA, Hackmann T, Chorney JM. Streamed video clips to reduce anxiety in children during inhaled induction of anesthesia. Anesth Analg. 2012;115:1162–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Isik B, Arslan M, Tunga AD, Kurtipek O. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr Anaesth. 2006;16(7):748–53.PubMedCrossRefGoogle Scholar
  42. 42.
    Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatr Anaesth. 2008;18(1):55–9.PubMedGoogle Scholar
  43. 43.
    Alhashemi JA, Daghistani MF. Effects of intraoperative i.v. acetaminophen vs i.m. meperidine on post-tonsillectomy pain in children. Br J Anaesth. 2006;96(6):790–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003;97(1):62–71.PubMedCrossRefGoogle Scholar
  45. 45.
    Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;144:S1–30.PubMedCrossRefGoogle Scholar
  46. 46.
    Brown KA. What we don’t know about childhood obstructive sleep apnea. Paediatr Anaesth. 2001;11:385–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Ward SL, Marcus CL. Obstructive sleep apnea in infants and young children. J Clin Neurophysiol. 1996;13:198–207.PubMedCrossRefGoogle Scholar
  48. 48.
    Sanders JC, King MA, Mitchell RB, Kelly JP. Perioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome. Anesth Analg. 2006;103(5):1115–21.PubMedCrossRefGoogle Scholar
  49. 49.
    Richmond KH, Wetmore RF, Baranak CC. Postoperative complications following tonsillectomy and adenoidectomy-who is at risk? Int J Pediatr Otorhinolaryngol. 1987;13:117–24.PubMedCrossRefGoogle Scholar
  50. 50.
    McColley SA, April MM, Carroll JL, Naclerio RM, Loughlin GM. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 1992;118(9):940–3.PubMedCrossRefGoogle Scholar
  51. 51.
    Francis A, Eltaki K, Bash T, Cortes S, Mojdehi K, Goldstein NA. The safety of preoperative sedation in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol. 2006;70:1517–21.PubMedCrossRefGoogle Scholar
  52. 52.
    Patel A, Davidson M, Tran MC, Quraishi H, Schoenberg C, Sant M, et al. Dexmedetomidine infusion for analgesia and prevention of emergence agitation in children with obstructive sleep apnea syndrome undergoing tonsillectomy and adenoidectomy. Anesth Analg. 2010;111:1004–10.PubMedGoogle Scholar
  53. 53.
    Ju NY, Cui GX, Gao W. Ropivacaine plus dexamethasone infiltration reduces postoperative pain after tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol. 2013;77:1881–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Brown KA, Morin I, Hickey C, Manoukian JJ, Nixon GM, Brouillette RT. Urgent adenotonsillectomy: an analysis of risk factors associated with postoperative respiratory morbidity. Anesthesiology. 2003;99:586–95.PubMedCrossRefGoogle Scholar
  55. 55.
    Ciszkowski C, Madadi P, Phillips MS, Lauwers AE, Koren G. Codeine, ultrarapid metabolism genotype, and postoperative death. N Engl J Med. 2009;361:827–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Pestieau SR, Quezado ZM, Johnson YJ, Anderson JL, Cheng YI, McCarter RJ, et al. High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children. Can J Anesthesiol. 2011;58:540–50.CrossRefGoogle Scholar
  57. 57.
    Bean-Lijewski JD, Kruitbosch SH, Hutchinson L, Browne B. Post-tonsillectomy pain management in children: can we do better? Otolaryngol Head Neck Surg. 2007;137:545–51.PubMedCrossRefGoogle Scholar
  58. 58.
    Mather SJ, Peutrell JM. Postoperative morphine requirements, nausea and vomiting following anaesthesia for tonsillectomy. Comparison of intravenous morphine and non-opioid analgesic techniques. Paediatr Anaesth. 1995;5:185–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Watters CH, Patterson CC, Mathews HM, Campbell W. Diclofenac sodium for post-tonsillectomy pain in children. Anaesthesia. 1988;43:641–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Unal Y, Pampal K, Korkmaz S, Arslan M, Zengin A, Kurtipek O. Comparison of bupivacaine and ropivacaine on postoperative pain after tonsillectomy in paediatric patients. Int J Pediatr Otorhinolaryngol. 2007;71:83–7.PubMedCrossRefGoogle Scholar
  61. 61.
    Atef A, Fawaz AA. Peritonsillar infiltration with tramadol improves pediatric tonsillectomy pain. Eur Arch Otorhinolaryngol. 2008;265:571–4.PubMedCrossRefGoogle Scholar
  62. 62.
    Cardwell M, Siviter G, Smith A. Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev. 2005.Google Scholar
  63. 63.
    Afman CE, Welge JA, Steward DL. Steroids for posttonsillectomy pain reduction: meta-analysis of randomized controlled trials. Otolaryngol Head Neck Surg. 2006;134:181–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Karaaslan K, Yilmaz F, Gulcu N, Sarpkaya A, Colak C, Kocoglu H. The effects of levobupivacaine versus levobupivacaine plus magnesium infiltration on postoperative analgesia and laryngospasm in pediatric tonsillectomy patients. Int J Pediatr Otorhinolaryngol. 2008;72(5):675–81.PubMedCrossRefGoogle Scholar
  65. 65.
    Heiba MH, Atef A, Mosleh M, Mohamed R, El-Hamamsy M. Comparison of peritonsillar infiltration of tramadol and lidocaine for the relief of post-tonsillectomy pain. J Laryngol Otol. 2012;126(11):1138–41.PubMedCrossRefGoogle Scholar
  66. 66.
    Jebeles JA, Reilly JS, Gutierrez JF, Bradley EL, Kissin I. The effect of preincisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia. Pain. 1991;47(3):305–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Molliex S, Haond P, Baylot D, Prades JM, Navez M, Elkhoury Z, et al. Effect of pre- vs. postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy. Acta Anaesthesiol Scand. 1996;40(10):1210–5.PubMedCrossRefGoogle Scholar
  68. 68.
    Bean-Lijewski JD. Glossopharyngeal nerve block for pain relief after pediatric tonsillectomy: retrospective analysis and two cases of life-threatening upper airway obstruction from an interrupted trial. Anesth Analg. 1997;84:1232–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Ohlms LA. Injection of local anesthetic in tonsillectomy. Arch Otolaryngol Head Neck Surg. 2001;127:1276–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Arens R, McDonough JM, Corbin AM, Rubin NK, Carroll ME, Pack AI, et al. Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2003;167:65–70.PubMedCrossRefGoogle Scholar
  71. 71.
    Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol. 1997;82:1319–26.PubMedCrossRefGoogle Scholar
  72. 72.
    Gozal D, Burnside MM. Increased upper airway collapsibility in children with obstructive sleep apnea during wakefulness. Am J Respir Crit Care Med. 2004;169:163–7.PubMedCrossRefGoogle Scholar
  73. 73.
    Bolton CM, Myles PS, Nolan T, Sterne JA. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth. 2006;97:593–604.PubMedCrossRefGoogle Scholar
  74. 74.
    Furst SR, Rodarte A. Prophylactic antiemetic treatment with ondansetron in children undergoing tonsillectomy. Anesthesiology. 1994;81:799–803.PubMedCrossRefGoogle Scholar
  75. 75.
    Stanko D, Bergesio R, Davies K, Hegarty M, Von Ungern-Sternberg BS. Postoperative pain, nausea and vomiting following adeno-tonsillectomy: a long-term follow-up. Pediatr Anesth. 2013;23:690–6.CrossRefGoogle Scholar
  76. 76.
    Carithers JS, Gebhart DE, Williams JA. Postoperative risks of pediatric tonsilloadenoidectomy. Laryngoscope. 1987;97:422-429.CrossRefGoogle Scholar
  77. 77.
    Ozmert S, Salman N, Sever F, Akin M, Saydam S, Keskin G, et al. Acupuncture as an antiemetic in children who underwent adenoidectomy and/or tonsillectomy. Turk J Anaesth Reanim. 2016;44:7–12.CrossRefGoogle Scholar
  78. 78.
    Myles PS, Williams D, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anesthesia and surgery: results of a prospective study of 10811 patients. Br J Anaesth. 2000;84:6–10.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    NIH Consensus Conference. Acupuncture. JAMA. 1998;280:1518–24.CrossRefGoogle Scholar
  80. 80.
    Streitberger K, Diefenbacher M, Bauer A, Conradi R, Bardenheuer H, Martin E, et al. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: a randomized placebo-controlled patient and observer blind trial. Anaesthesia. 2004;59:142–9.PubMedCrossRefGoogle Scholar
  81. 81.
    Junior DR, Neubauer AG, Ranieri DM, Junior PN. The use of disposable laryngeal mask airway for adenotonsillectomies. Rev Bras Anestesiol. 2012;62(6):788–98.CrossRefGoogle Scholar
  82. 82.
    Alalami AA, Ayoub CM, Baraka AS. Laryngospasm: review of different prevention and treatment modalities. Paediatr Anaesth. 2008;18(4):281–8.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Peng A, Dodson KM, Thacker LR, Kierce J, Shapiro J, Baldassari C. Use of laryngeal mask airway in pediatric adenotonsillectomy. Arch Otolaryngol Head Neck Surg. 2011;137(1):42–6.PubMedCrossRefGoogle Scholar
  84. 84.
    Williams PJ, Bailey PM. Comparison of the reinforced laryngeal mask airway and tracheal intubation for adenotonsillectomy. Br J Anaesth. 1993;70:30–3.PubMedCrossRefGoogle Scholar
  85. 85.
    Webster AC, Morley-Forster PK, Dain S, et al. Anaesthesia for adenotonsillectomy: a comparison between tracheal intubation and the armoured laryngeal mask airway. Can J Anaesth. 1993;40(12):1171–7.PubMedCrossRefGoogle Scholar
  86. 86.
    Heath ML, Sinnathamby SW. The reinforced laryngeal mask airway for adenotonsillectomy. Br J Anaesth. 1994;72(6):728–9.PubMedCrossRefGoogle Scholar
  87. 87.
    Roy S, Smith LP. Prevention of airway fires: testing the safety of endotracheal tubes and surgical devices in a mechanical model. Am J Otolaryngol. 2015;36(1):63–6.PubMedCrossRefGoogle Scholar
  88. 88.
    Akhtar N, Ansar F, Baig MS, Abbas A. Airway fires during surgery: management and prevention. J Anaesthesiol Clin Pharmacol. 2016;32(1):109–11.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Apfelbaum JL, Caplan RA, Barker SJ, Connis RT, Cowles C, Ehrenwerth J, et al. Practice Advisory for the Prevention and Management of Operating Room Fires: An Updated Report by the American Society of Anesthesiologists Task Force on Operating Room Fires. Anesthesiology. 2013;118(2):271–90.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Cooley WC, Graham JM. Down syndrome-an update and review for the primary pediatrician. Clin Pediatr (Phila). 1991;30:233–53.CrossRefGoogle Scholar
  91. 91.
    Clark RW, Schmidt HS, Schuller DE. Sleep-induced ventilatory dysfunction in Down’s syndrome. Arch Intern Med. 1980;140:45–50.PubMedCrossRefGoogle Scholar
  92. 92.
    Loughlin GM, Wynne JW, Victoria BE. Sleep apnea as a possible cause of pulmonary hypertension in Down syndrome. J Pediatr. 1981;98:435–7.PubMedCrossRefGoogle Scholar
  93. 93.
    Strome M. Obstructive sleep apnea in Down syndrome children: a surgical approach. Laryngoscope. 1986;96:1340-1342.CrossRefGoogle Scholar
  94. 94.
    Goldstein NA, Armfield DR, Kingsley LA, Borland LM, Allen GC, Post JC. Postoperative complications after tonsillectomy and adenoidectomy in children with down syndrome. Arch Otolaryngol Head Neck Surg. 1998;124:171–6.PubMedCrossRefGoogle Scholar
  95. 95.
    Gleadhill IC, Schwartz AR, Schubert N, Wise RA, Permutt S, Smith PL. Upper airway collapsibility in snorers and in patients with obstructive hypopnea and apnea. Am Rev Respir Dis. 1991;143(6):1300–3.PubMedCrossRefGoogle Scholar
  96. 96.
    Thut DC, Schwart AR, Roach D, Wise RA, Permutt S, Smith PL. Tracheal and neck position influence upper airway airflow dynamics by altering airway length. J Appl Physio. 1993;75:2084–90.CrossRefGoogle Scholar
  97. 97.
    Litman RS, Wake N, Chan LM, McDonough JM, Sin S, Mahboubi S, et al. Effect of lateral positioning on upper airway size and morphology in sedated children. Anesthesiology. 2005;103(3):484–8.PubMedCrossRefGoogle Scholar
  98. 98.
    Arai YC, Fukunaga K, Hirota S, Fujimoto S. The effects of chin lift and jaw thrust while in the lateral position on stridor score in anesthetized children with adenotonsillar hypertrophy. Anesth Analg. 2004;99:1638–41.PubMedCrossRefGoogle Scholar
  99. 99.
    Isono S, Tanaka A, Nishino T. Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea. Anesthesiology. 2002;97:780–5.PubMedCrossRefGoogle Scholar
  100. 100.
    Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676–83.PubMedCrossRefGoogle Scholar
  101. 101.
    Nixon GM, Kermack AS, McGregor CD, David GM, Manoukian JJ, Brown KA. Sleep and breathing on the first night after adenotonsillectomy for obstructive sleep apnea. Pediatr Pulmonol. 2005;39(4):332–8.PubMedCrossRefGoogle Scholar
  102. 102.
    Helfaer MA, McColley SA, Pyzik PL, Tunkel DE, Nichols DG, Baroody FM, et al. Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea. Crit Care Med. 1996;24(8):1323–7.PubMedCrossRefGoogle Scholar
  103. 103.
    Crysdale WS, Russel D. Complications of tonsillectomy and adenoidectomy in 9409 children observed overnight. CMAJ. 1986;135:1139–42.PubMedPubMedCentralGoogle Scholar
  104. 104.
    Connor CM, Craig HK, Raudenbush SW, Heavner K, Zwolan TA. The age at which young deaf children receive cochlear implants and their vocabulary and speech- production growth: is there an added value for early implantation? Ear Hear. 2006;27(6):628–44.PubMedCrossRefGoogle Scholar
  105. 105.
    O’Donoghue GM. Hearing without ears: do cochlear implants work in children? Yes, so long as they are given to the right children early enough. BMJ. 1999;318:72–3.PubMedPubMedCentralCrossRefGoogle Scholar
  106. 106.
    Balkany TJ, Hodges AV, Miyamoto RT, et al. Cochlear implants in children. Otolaryngol Clin N Am. 2001;34:455–67.CrossRefGoogle Scholar
  107. 107.
    Darlong V, Khanna P, Baidya DK, Chandralekha PR, Punj J. Perioperative complications of cochlear implant surgery in children. J Anesth. 2015;29:126.PubMedCrossRefGoogle Scholar
  108. 108.
    Hawksworth C, Ravury S. An audit of anesthesia safety in a pediatric cochlear implantation program. Paediatr Anaesth. 2015;25:630–5.PubMedCrossRefGoogle Scholar
  109. 109.
    Crawford MW, White MC, Propst EJ, Zaarour C, Cushing S, Pehora C, et al. Dose-dependent suppression of the electrically elicited stapedius reflex by general anesthetics in children undergoing cochlear implant surgery. Anesth Analg. 2009;108:1480–7.PubMedCrossRefGoogle Scholar
  110. 110.
    Schultz A, Berger FA, Weber BP, Groven U, Niclaus O, Lüllwitz E, et al. Intraoperative electrically elicited stapedius reflex threshold is related to the dosage of hypnotic drugs in general anaesthesia. Ann Otol Rhinol Laryngol. 2003;112:1050–5.PubMedCrossRefGoogle Scholar
  111. 111.
    Jöhr M, Ho A, Wagner CS, Linder T. Ear surgery in infants under one year of age: its risks and implications for cochlear implant surgery. Otol Neurotol. 2008;29:310–3.PubMedCrossRefGoogle Scholar
  112. 112.
    Yeo J, Jung J, Ryu T, Jeon YH, Kim S, Baek W. Antiemetic efficacy of dexamethasone combined with midazolam after middle ear surgery. Otolaryngol Head Neck Surg. 2009;141:684–8.PubMedCrossRefGoogle Scholar
  113. 113.
    Baidya DK, Dehran M. Anesthesia for cochlear implant surgery. Trends Anaesth Crit Care. 2011;1:90–4.CrossRefGoogle Scholar
  114. 114.
    Wong I, John-Green C, Walker SM. Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Pediatr Anesth. 2013;23:475–95.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Monica Shah
    • 1
  • Mofya S. Diallo
    • 1
  1. 1.Division of Anesthesiology, Sedation and Perioperative MedicineChildren’s National Health System, The George Washington UniversityWashington, DCUSA

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