Anesthesia for Ear, Nose and Throat Surgery in Children
Ear, nose and throat surgery is the commonest reason for anesthesia in children. It has unique challenges of a shared and potentially soiled airway as well as the possibility of postoperative airway obstruction. This chapter discusses common, elective ENT procedures as well as pain management and complications. It also details the management of potentially life-threatening emergencies such as the bleeding tonsil and neck abscesses. Tonsillectomy is usually performed for obstructive sleep apnea (OSA) in preschool-aged children. Children with OSA have an increased sensitivity to opioids and multimodal analgesia is essential to minimize the opioid dose, or to avoid opioids altogether. Syndromic children with anatomical narrowing of the upper airway are at additional risk. Non-steroidal anti-inflammatory drugs are important after tonsillectomy, but there are still concerns regarding bleeding. Dexamethasone improves oral intake, reduces pain, nausea and vomiting, and should be given routinely. Bleeding after tonsillectomy occurs in about 1% of cases, although most cases have a small bleeding point and the main anesthetic issue is blood in the stomach. Rarely, others have an arterial bleeding point, and their mouth fills with blood between induction and laryngoscopy. The LMA potentially retrieves the airway in these cases when intubation is not possible. Superficial neck abscesses are common in children and are caused by infected lymph nodes. Deeper neck abscesses are rare, but can cause airway obstruction and difficult intubation.
KeywordsAnesthesia for tonsillectomy Anesthesia for neck abscesses in children Pediatric OSA Dexamethasone in tonsillectomy
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- Tonsillectomy and adenoidectomy in children with sleep related breathing disorders. Consensus statement of a UK multidisciplinary working party. 2010. https://www.rcoa.ac.uk/document-store/tonsillectomy-and-adenoidectomy-children-sleep-related-breathing-disorders. Accessed July 2019.