Skip to main content

Anesthetic Management of Morbidly Obese Patients Undergoing Airway Surgery

  • Chapter
  • First Online:
  • 795 Accesses

Abstract

Obesity has become one of the most important public health problems in the United States and many other countries around the world (Afshin et al., N Engl J Med 377(1):13–27, 2017). In the United States, prevalence of childhood obesity has increased up to threefold over the last three decades (Hedley et al., JAMA 291(23):2847–2850, 2004; Ogden et al., JAMA 311(8):806–814, 2014). It now affects one in six children and adolescents with the highest prevalence in Black and Mexican-American youth (Skelton et al., Acad Pediatr 9(5):322–329, 2009). According to Center for Disease Control and Prevention (CDC) 2011–2014 report, the prevalence of obesity was 17.5% of among 6–11-year-olds and 20.5% of 12–19-year-olds (Ogden et al., Ctr Dis Control Prev, 2015). More than 30% of pediatric patients presenting for surgery in one large pediatric setting were found to be overweight or obese (Nafiu et al., J Natl Med Assoc 99(1):46–48, 50–41, 2007).

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.

    Article  PubMed  Google Scholar 

  2. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291(23):2847–50.

    Article  CAS  PubMed  Google Scholar 

  3. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Skelton JA, Cook SR, Auinger P, Klein JD, Barlow SE. Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr. 2009;9(5):322–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. NCHS Data Brief. 2015;(219):1–8.

    Google Scholar 

  6. Nafiu OO, Ndao-Brumlay KS, Bamgbade OA, Morris M, Kasa-Vubu JZ. Prevalence of overweight and obesity in a U.S. pediatric surgical population. J Natl Med Assoc. 2007;99(1).:46–48, 50–41.

    Google Scholar 

  7. El-Metainy S, Ghoneim T, Aridae E, Abdel Wahab M. Incidence of perioperative adverse events in obese children undergoing elective general surgery. Br J Anaesth. 2011;106(3):359–63.

    Article  CAS  PubMed  Google Scholar 

  8. Cote CJ, Posner KL, Domino KB. Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: Houston, we have a problem! Anesth Analg. 2014;118(6):1276–83.

    Article  PubMed  Google Scholar 

  9. Nafiu OO, Curcio C. Simplified table to identify overweight and obese children undergoing anesthesia. Paediatr Anaesth. 2013;23(10):964–6.

    Article  PubMed  Google Scholar 

  10. Nafiu OO, Prasad Y, Chimbira WT. Association of childhood high body mass index and sleep disordered breathing with perioperative laryngospasm. Int J Pediatr Otorhinolaryngol. 2013;77(12):2044–8.

    Article  PubMed  Google Scholar 

  11. Arens R, Muzumdar H. Childhood obesity and obstructive sleep apnea syndrome. J Appl Physiol (1985). 2010;108(2):436–44.

    Article  Google Scholar 

  12. Andersen IG, Holm JC, Homoe P. Obstructive sleep apnea in obese children and adolescents, treatment methods and outcome of treatment – a systematic review. Int J Pediatr Otorhinolaryngol. 2016;87:190–7.

    Article  PubMed  Google Scholar 

  13. Mathew JL, Narang I. Sleeping too close together: obesity and obstructive sleep apnea in childhood and adolescence. Paediatr Respir Rev. 2014;15(3):211–8.

    PubMed  Google Scholar 

  14. Schwengel DA, Dalesio NM, Stierer TL. Pediatric obstructive sleep apnea. Anesthesiol Clin. 2014;32(1):237–61.

    Article  PubMed  Google Scholar 

  15. American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014;120(2):268–86.

    Article  Google Scholar 

  16. Mitchell RB, Garetz S, Moore RH, et al. The use of clinical parameters to predict obstructive sleep apnea syndrome severity in children: the Childhood Adenotonsillectomy (CHAT) study randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2015;141(2):130–6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Roland PS, Rosenfeld RM, Brooks LJ, et al. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;145(1 Suppl):S1–15.

    Article  PubMed  Google Scholar 

  18. Philippi-Hohne C. Anaesthesia in the obese child. Best Pract Res Clin Anaesthesiol. 2011;25(1):53–60.

    Article  PubMed  CAS  Google Scholar 

  19. Mortensen A, Lenz K, Abildstrom H, Lauritsen TL. Anesthetizing the obese child. Paediatr Anaesth. 2011;21(6):623–9.

    Article  PubMed  Google Scholar 

  20. Burke CN, Voepel-Lewis T, Wagner D, et al. A retrospective description of anesthetic medication dosing in overweight and obese children. Paediatr Anaesth. 2014;24(8):857–62.

    Article  PubMed  Google Scholar 

  21. Wells JC, Fewtrell MS, Williams JE, Haroun D, Lawson MS, Cole TJ. Body composition in normal weight, overweight and obese children: matched case-control analyses of total and regional tissue masses, and body composition trends in relation to relative weight. Int J Obes. 2006;30(10):1506–13.

    Article  CAS  Google Scholar 

  22. De Baerdemaeker L, Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anaesthesiol. 2016;29(1):119–28.

    Article  PubMed  CAS  Google Scholar 

  23. Sinha AC, Singh PM. Optimal drug dosing in the obese–still many years ahead. Obes Surg. 2015;25(11):2159–60.

    Article  PubMed  Google Scholar 

  24. Olutoye OA, Yu X, Govindan K, et al. The effect of obesity on the ED(95) of propofol for loss of consciousness in children and adolescents. Anesth Analg. 2012;115(1):147–53.

    Article  CAS  PubMed  Google Scholar 

  25. Ingrande J, Brodsky JB, Lemmens HJ. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg. 2011;113(1):57–62.

    Article  CAS  PubMed  Google Scholar 

  26. Diepstraten J, Chidambaran V, Sadhasivam S, et al. Propofol clearance in morbidly obese children and adolescents: influence of age and body size. Clin Pharmacokinet. 2012;51(8):543–51.

    Article  CAS  PubMed  Google Scholar 

  27. Brill MJ, van Rongen A, Houwink AP, et al. Midazolam pharmacokinetics in morbidly obese patients following semi-simultaneous oral and intravenous administration: a comparison with healthy volunteers. Clin Pharmacokinet. 2014;53(10):931–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hannallah R, Brown K, Verghese S. Otorhinolaryngologic procedures. In: Coté CJ, Lerman J, Anderson BJ, editors. A practice of anesthesia for infants and children. 6th ed. Philadelphia: Elsevier; 2017: (in press).

    Google Scholar 

  29. Lerman J. Unraveling the mysteries of sleep-disordered breathing in children. Anesthesiology. 2006;105(4):645–7.

    Article  PubMed  Google Scholar 

  30. Brown KA, Laferrière A, Lakheeram I, Moss IR. Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology. 2006;105(4):665–9.

    Article  PubMed  Google Scholar 

  31. Coté CJ. Anesthesiological considerations for children with obstructive sleep apnea. Curr Opin Anaesthesiol. 2015;28(3):327–32.

    Article  PubMed  CAS  Google Scholar 

  32. Mulier JP. Perioperative opioids aggravate obstructive breathing in sleep apnea syndrome: mechanisms and alternative anesthesia strategies. Curr Opin Anaesthesiol. 2016;29(1):129–33.

    Article  CAS  PubMed  Google Scholar 

  33. Vaughns JD, Martin C, Nelson J, Nadler E, Quezado ZM. Dexmedetomidine as an adjuvant for perioperative pain management in adolescents undergoing bariatric surgery: an observational cohort study. J Pediatr Surg. 2017;52:1787.

    Article  PubMed  Google Scholar 

  34. Singh PM, Panwar R, Borle A, Mulier JP, Sinha A, Goudra B. Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis. Surg Obes Relat Dis. 2017;13(8):1434–46.

    Article  PubMed  Google Scholar 

  35. Cook-Sather SD, Gallagher PR, Kruge LE, et al. Overweight/obesity and gastric fluid characteristics in pediatric day surgery: implications for fasting guidelines and pulmonary aspiration risk. Anesth Analg. 2009;109(3):727–36.

    Article  PubMed  Google Scholar 

  36. Hannallah RS. Pediatric patient selection for ambulatory surgery centers in. Refresher course lecture summaries at anesthesiology 2016 meeting. Chicago. p. 167–72.

    Google Scholar 

  37. Soltesz S, Dittrich K, Teschendorf P, Fuss I, Molter G. Topical anesthesia before vascular access in children. Comparison of a warmth-producing lidocaine-tetracaine patch with a lidocaine-prilocaine patch. Anaesthesist. 2010;59(6):519–23.

    Article  CAS  PubMed  Google Scholar 

  38. Nafiu OO, Burke C, Cowan A, Tutuo N, Maclean S, Tremper KK. Comparing peripheral venous access between obese and normal weight children. Paediatr Anaesth. 2010;20(2):172–6.

    Article  PubMed  Google Scholar 

  39. Benkhadra M, Collignon M, Fournel I, et al. Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study. Paediatr Anaesth. 2012;22(5):449–54.

    Article  PubMed  Google Scholar 

  40. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;144(1 Suppl):S1–30.

    Article  PubMed  Google Scholar 

  41. Gleich SJ, Olson MD, Sprung J, et al. Perioperative outcomes of severely obese children undergoing tonsillectomy. Paediatr Anaesth. 2012;22(12):1171–8.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lavin JM, Shah RK. Postoperative complications in obese children undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2015;79(10):1732–5.

    Article  PubMed  Google Scholar 

  43. Keamy DG, Chhabra KR, Hartnick CJ. Predictors of complications following adenotonsillectomy in children with severe obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2015;79(11):1838–41.

    Article  PubMed  Google Scholar 

  44. Kasle D, Virbalas J, Bent JP, Cheng J. Tonsillectomies and respiratory complications in children: a look at pre-op polysomnography risk factors and post-op admissions. Int J Pediatr Otorhinolaryngol. 2016;88:224–7.

    Article  PubMed  Google Scholar 

  45. Schwengel DA, Sterni LM, Tunkel DE, Heitmiller ES. Perioperative management of children with obstructive sleep apnea. Anesth Analg. 2009;109(1):60–75.

    Article  PubMed  Google Scholar 

  46. Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med. 2012;8(2):199–207.

    PubMed  PubMed Central  Google Scholar 

  47. Castorena-Maldonado A, Torre-Bouscoulet L, Meza-Vargas S, Vázquez-García JC, López-Escárcega E, Pérez-Padilla R. Preoperative continuous positive airway pressure compliance in children with obstructive sleep apnea syndrome: assessed by a simplified approach. Int J Pediatr Otorhinolaryngol. 2008;72(12):1795–800.

    Article  CAS  PubMed  Google Scholar 

  48. 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(9):1517–21.

    Article  PubMed  Google Scholar 

  49. Viitanen H, Annila P, Viitanen M, Tarkkila P. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg. 1999;89(1):75–9.

    CAS  PubMed  Google Scholar 

  50. Viitanen H, Annila P, Viitanen M, Yli-Hankala A. Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1–3 yr. Can J Anaesth. 1999;46(8):766–71.

    Article  CAS  PubMed  Google Scholar 

  51. Mort TC, Tighe D. Emergency non-operating room airway management of the morbidly obese patient: trends and complications. In: Anesthesiology news airway management; 2017. p. 37–58.

    Google Scholar 

  52. Shah U, Wong J, Wong DT, Chung F. Preoxygenation and intraoperative ventilation strategies in obese patients: a comprehensive review. Curr Opin Anaesthesiol. 2016;29(1):109–18.

    Article  CAS  PubMed  Google Scholar 

  53. Gander S, Frascarolo P, Suter M, Spahn DR, Magnusson L. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg. 2005;100(2):580–4.

    Article  PubMed  Google Scholar 

  54. 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 (Journal canadien d’anesthesie). 1993;40(12):1171–7.

    Article  CAS  Google Scholar 

  55. Peng A, Dodson KM, Thacker LR, Kierce J, Shapiro J, Baldassari CM. Use of laryngeal mask airway in pediatric adenotonsillectomy. Arch Otolaryngol Head Neck Surg. 2011;137(1):42–6.

    Article  PubMed  Google Scholar 

  56. Lescanne E, Chiron B, Constant I, et al. Pediatric tonsillectomy: clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis. 2012;129(5):264–71.

    Article  CAS  PubMed  Google Scholar 

  57. Kristensen MS. Airway management and morbid obesity. Eur J Anaesthesiol. 2010;27(11):923–7.

    Article  PubMed  Google Scholar 

  58. Hern JD, Jayaraj SM, Sidhu VS, Almeyda JS, O’Neill G, Tolley NS. The laryngeal mask airway in tonsillectomy: the surgeon's perspective. Clin Otolaryngol Allied Sci. 1999;24(2):122–5.

    Article  CAS  PubMed  Google Scholar 

  59. Sierpina DI, Chaudhary H, Walner DL, et al. Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy. Laryngoscope. 2012;122(2):429–35.

    Article  PubMed  Google Scholar 

  60. Gravningsbraten R, Nicklasson B, Raeder J. Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomy. Acta Anaesthesiol Scand. 2009;53(2):218–22.

    Article  CAS  PubMed  Google Scholar 

  61. Yumul R, Elvir-Lazo OL, White PF, et al. Comparison of three video laryngoscopy devices to direct laryngoscopy for intubating obese patients: a randomized controlled trial. J Clin Anesth. 2016;31:71–7.

    Article  PubMed  Google Scholar 

  62. Sun Y, Lu Y, Huang Y, Jiang H. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2014;24(10):1056–65.

    Article  PubMed  Google Scholar 

  63. Baraka AS, Taha SK, Siddik-Sayyid SM, et al. Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia. 2007;62(8):769–73.

    Article  CAS  PubMed  Google Scholar 

  64. Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. J Clin Anesth. 2010;22(3):164–8.

    Article  PubMed  Google Scholar 

  65. Heard A, Toner AJ, Evans JR, Aranda Palacios AM, Lauer S. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of buccal RAE tube oxygen administration. Anesth Analg. 2017;124(4):1162–7.

    Article  PubMed  Google Scholar 

  66. Humphreys S, Lee-Archer P, Reyne G, Long D, Williams T, Schibler A. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in children: a randomized controlled trial. Br J Anaesth. 2017;118(2):232–8.

    Article  CAS  PubMed  Google Scholar 

  67. Welborn LG, Hannallah RS, Norden JM, Ruttimann UE, Callan CM. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg. 1996;83(5):917–20.

    Article  CAS  PubMed  Google Scholar 

  68. Mayer J, Boldt J, Rohm KD, Scheuermann K, Suttner SW. Desflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance. Anesth Analg. 2006;102(2):400–4.

    Article  CAS  PubMed  Google Scholar 

  69. Nafiu OO, Shanks A, Abdo S, Taylor E, Tremper TT. Association of high body mass index in children with early post-tonsillectomy pain. Int J Pediatr Otorhinolaryngol. 2013;77(2):256–61.

    Article  PubMed  Google Scholar 

  70. Carron M, Veronese S, Foletto M, Ori C. Sugammadex allows fast-track bariatric surgery. Obes Surg. 2013;23(10):1558–63.

    Article  PubMed  Google Scholar 

  71. Anderson BJ, Woollard GA, Holford NH. Acetaminophen analgesia in children: placebo effect and pain resolution after tonsillectomy. Eur J Clin Pharmacol. 2001;57(8):559–69.

    Article  CAS  PubMed  Google Scholar 

  72. Marret E, Flahault A, Samama CM, Bonnet F. Effects of postoperative, nonsteroidal, antiinflammatory drugs on bleeding risk after tonsillectomy: meta-analysis of randomized, controlled trials. Anesthesiology. 2003;98(6):1497–502.

    Article  PubMed  Google Scholar 

  73. Cardwell M, Siviter G, Smith A. Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev. 2005;2:CD003591.

    Google Scholar 

  74. Mills N, Anderson BJ, Barber C, et al. Day stay pediatric tonsillectomy–a safe procedure. Int J Pediatr Otorhinolaryngol. 2004;68(11):1367–73.

    Article  PubMed  Google Scholar 

  75. Dsida RM, Wheeler M, Birmingham PK, et al. Age-stratified pharmacokinetics of ketorolac tromethamine in pediatric surgical patients. Anesth Analg. 2002;94(2):266–70, table of contents.

    Article  CAS  PubMed  Google Scholar 

  76. Agrawal A, Gerson CR, Seligman I, Dsida RM. Postoperative hemorrhage after tonsillectomy: use of ketorolac tromethamine. Otolaryngol Head Neck Surg. 1999;120(3):335–9.

    Article  CAS  PubMed  Google Scholar 

  77. Mattos JL, Robison JG, Greenberg J, Yellon RF. Acetaminophen plus ibuprofen versus opioids for treatment of post-tonsillectomy pain in children. Int J Pediatr Otorhinolaryngol. 2014;78(10):1671–6.

    Article  PubMed  Google Scholar 

  78. Liu C, Ulualp SO. Outcomes of an alternating ibuprofen and acetaminophen regimen for pain relief after tonsillectomy in children. Ann Otol Rhinol Laryngol. 2015;124(10):777–81.

    Article  PubMed  Google Scholar 

  79. Elhakim M, Ali NM, Rashed I, Riad MK, Refat M. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Can J Anaesth (Journal canadien d’anesthesie). 2003;50(4):392–7.

    Article  Google Scholar 

  80. Czarnetzki C, Elia N, Lysakowski C, et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA. 2008;300(22):2621–30.

    Article  CAS  PubMed  Google Scholar 

  81. Windfuhr JP, Chen YS, Propst EJ, Guldner C. The effect of dexamethasone on post-tonsillectomy nausea, vomiting and bleeding. Braz J Otorhinolaryngol. 2011;77(3):373–9.

    Article  PubMed  Google Scholar 

  82. Shakeel M, Trinidade A, Al-Adhami A, et al. Intraoperative dexamethasone and the risk of secondary posttonsillectomy hemorrhage. J Otolaryngol Head Neck Surg (Le Journal d’oto-rhino-laryngologie et de chirurgie cervico-faciale). 2010;39(6):732–6.

    Google Scholar 

  83. Brigger MT, Cunningham MJ, Hartnick CJ. Dexamethasone administration and postoperative bleeding risk in children undergoing tonsillectomy. Arch Otolaryngol Head Neck Surg. 2010;136(8):766–72.

    Article  PubMed  Google Scholar 

  84. Geva A, Brigger MT. Dexamethasone and tonsillectomy bleeding: a meta-analysis. Otolaryngol Head Neck Surg. 2011;144(6):838–43.

    Article  PubMed  Google Scholar 

  85. Plante J, Turgeon AF, Zarychanski R, et al. Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical Research ed). 2012;345:e5389.

    Google Scholar 

  86. Corcoran TB, Truyens EB, Ng A, Moseley N, Doyle AC, Margetts L. Anti-emetic dexamethasone and postoperative infection risk: a retrospective cohort study. Anaesth Intensive Care. 2010;38(4):654–60.

    CAS  PubMed  Google Scholar 

  87. Chanimov M, Koren-Michowitz M, Cohen ML, Pilipodi S, Bahar M. Tumor lysis syndrome induced by dexamethasone. Anesthesiology. 2006;105(3):633–4.

    Article  PubMed  Google Scholar 

  88. McDonnell C, Barlow R, Campisi P, Grant R, Malkin D. Fatal peri-operative acute tumour lysis syndrome precipitated by dexamethasone. Anaesthesia. 2008;63(6):652–5.

    Article  CAS  PubMed  Google Scholar 

  89. Wong AK, Bissonnette B, Braude BM, Macdonald RM, St-Louis PJ, Fear DW. Post-tonsillectomy infiltration with bupivacaine reduces immediate postoperative pain in children. Can J Anaesth (Journal canadien d’anesthesie). 1995;42(9):770–4.

    Article  CAS  Google Scholar 

  90. 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(6):1232–8.

    Article  CAS  PubMed  Google Scholar 

  91. Ohlms LA. Injection of local anesthetic in tonsillectomy. Arch Otolaryngol Head Neck Surg. 2001;127(10):1276–8.

    Article  CAS  PubMed  Google Scholar 

  92. Patel A, Davidson M, Tran MC, 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(4):1004–10.

    CAS  PubMed  Google Scholar 

  93. Pestieau SR, Quezado ZM, Johnson YJ, et al. High-dose dexmedetomidine increases the opioid-free interval and decreases opioid requirement after tonsillectomy in children. Can J Anaesth (Journal canadien d’anesthesie). 2011;58(6):540–50.

    Article  Google Scholar 

  94. He XY, Cao JP, Shi XY, Zhang H. Dexmedetomidine versus morphine or fentanyl in the management of children after tonsillectomy and adenoidectomy: a meta-analysis of randomized controlled trials. Ann Otol Rhinol Laryngol. 2013;122(2):114–20.

    Article  PubMed  Google Scholar 

  95. Bameshki SA, Salari MR, Bakhshaee M, Razavi M. Effect of ketamine on post-tonsillectomy sedation and pain relief. Iran J Otorhinolaryngol. 2015;27(83):429–34.

    PubMed  PubMed Central  Google Scholar 

  96. Kimiaei Asadi H, Nikooseresht M, Noori L, Behnoud F. The effect of administration of ketamine and paracetamol versus paracetamol singly on postoperative pain, nausea and vomiting after pediatric adenotonsillectomy. Anesth Pain Med. 2016;6(1):e31210.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Racoosin JA, Roberson DW, Pacanowski MA, Nielsen DR. New evidence about an old drug–risk with codeine after adenotonsillectomy. N Engl J Med. 2013;368(23):2155–7.

    Article  CAS  PubMed  Google Scholar 

  98. Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017;8:CD012763.

    PubMed  Google Scholar 

  99. Gaszynski T, Szewczyk T, Gaszynski W. Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia. Br J Anaesth. 2012;108(2):236–9.

    Article  CAS  PubMed  Google Scholar 

  100. Litman RS, Wake N, Chan LM, et al. Effect of lateral positioning on upper airway size and morphology in sedated children. Anesthesiology. 2005;103(3):484–8.

    Article  PubMed  Google Scholar 

  101. Nardone HC, McKee-Cole KM, Friedman NR. Current pediatric tertiary care admission practices following adenotonsillectomy. JAMA Otolaryngol Head Neck Surg. 2016;142(5):452–6.

    Article  PubMed  Google Scholar 

  102. Fung E, Cave D, Witmans M, Gan K, El-Hakim H. Postoperative respiratory complications and recovery in obese children following adenotonsillectomy for sleep-disordered breathing: a case-control study. Otolaryngol Head Neck Surg. 2010;142(6):898–905.

    Article  PubMed  Google Scholar 

  103. Friedman O, Chidekel A, Lawless ST, Cook SP. Postoperative bilevel positive airway pressure ventilation after tonsillectomy and adenoidectomy in children–a preliminary report. Int J Pediatr Otorhinolaryngol. 1999;51(3):177–80.

    Article  CAS  PubMed  Google Scholar 

  104. Tweedie DJ, Bajaj Y, Ifeacho SN, et al. Peri-operative complications after adenotonsillectomy in a UK pediatric tertiary referral centre. Int J Pediatr Otorhinolaryngol. 2012;76(6):809–15.

    Article  CAS  PubMed  Google Scholar 

  105. Mahmoud M, Radhakrishman R, Gunter J, et al. Effect of increasing depth of dexmedetomidine anesthesia on upper airway morphology in children. Paediatr Anaesth. 2010;20(6):506–15.

    Article  PubMed  Google Scholar 

  106. Mahmoud M, Jung D, Salisbury S, et al. Effect of increasing depth of dexmedetomidine and propofol anesthesia on upper airway morphology in children and adolescents with obstructive sleep apnea. J Clin Anesth. 2013;25(7):529–41.

    Article  CAS  PubMed  Google Scholar 

  107. Yoon BW, Hong JM, Hong SL, Koo SK, Roh HJ, Cho KS. A comparison of dexmedetomidine versus propofol during drug-induced sleep endoscopy in sleep apnea patients. Laryngoscope. 2016;126(3):763–7.

    Article  CAS  PubMed  Google Scholar 

  108. Ehsan Z, Mahmoud M, Shott SR, Amin RS, Ishman SL. The effects of anesthesia and opioids on the upper airway: a systematic review. Laryngoscope. 2016;126(1):270–84.

    Article  CAS  PubMed  Google Scholar 

  109. Eikermann M, Grosse-Sundrup M, Zaremba S, et al. Ketamine activates breathing and abolishes the coupling between loss of consciousness and upper airway dilator muscle dysfunction. Anesthesiology. 2012;116(1):35–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  110. Kandil A, Subramanyam R, Hossain MM, et al. Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug-induced sleep endoscopy in children. Paediatr Anaesth. 2016;26(7):742–51.

    Article  PubMed  Google Scholar 

  111. Barry RA, Fink DS, Pourciau DC, et al. Effect of increased body mass index on complication rates during laryngotracheal surgery utilizing jet ventilation. Otolaryngol Head Neck Surg. 2017;157(3):473–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Songyos Valairucha .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Valairucha, S., Hannallah, R.S. (2019). Anesthetic Management of Morbidly Obese Patients Undergoing Airway Surgery. In: Preciado, D., Verghese, S. (eds) Anesthetic Management for the Pediatric Airway . Springer, Cham. https://doi.org/10.1007/978-3-030-04600-2_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-04600-2_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-04599-9

  • Online ISBN: 978-3-030-04600-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics