A national survey of the anesthetic management of tonsillectomy surgery in children

Abstract

Background: Tonsillectomy in children is a common procedure; however, there appears to be a significant degree of variability in anesthetic management. Thus far, there has been no large national survey looking at the perioperative care of these children.

Objectives: We conducted a national survey with the aim of determining what represents common practice in the perioperative management of children undergoing tonsillectomy surgery. We compared the respondents' management against evidence-based practice.

Methods: The survey took the form of a questionnaire, which was sent to members of The Association of Paediatric Anaesthetists (APAGBI) and to Royal College tutors. The questionnaire was sent in paper format to the College Tutors and in digital format to APAGBI members. Emphasis was placed upon preoperative preparation, induction technique, airway management, analgesia, postoperative nausea and vomiting strategy, fluid management and emergence from anesthesia.

Results: Responses were obtained from 173 individuals representing a broad cross-section of anesthetists from teaching and district general hospitals. Findings are as follows: the application of topical anesthetic cream is commonplace (93%), with Ametop being the primary preparation used; the intravenous route was preferred to induce anesthesia; most practitioners intubate the trachea to maintain the airway during anesthesia (79%); a muscle relaxant was employed to assist intubation of the trachea in 47% of respondents and the routine use of suxamethonium was reported to be uncommon (9%); the administration of prophylactic ondansetron and dexamethasone was reported by 79% and 70% of respondents respectively; and nonsteroidal anti-inflammatory drugs (NSAIDs) are used by 77% of individuals either pre-emptively or during the intraoperative period.

Conclusions: Whilst there is individual variability in the management of these cases, the majority of anesthetists prefer the intravenous route for induction of anesthesia, after application of topical anesthetic cream. It is routine practice to intubate the trachea, administer paracetamol, NSAIDs, strong opiates and antiemetics.