Ambulatory adenotonsillectomy in children less than 5 years of age.

OBJECTIVE: Post-tonsillectomy monitoring has received a significant amount of attention in recent years. Although the literature questions the safety of ambulatory adenotonsillectomy in children less than 5 years of age, age alone did not exclude eligibility for day surgery at our institution. METHOD: A retrospective chart review was performed between 1995 and 1998 for all children who had undergone adenoidectomy or adenotonsillectomy at the London Health Sciences Centre in London, ON. RESULTS: There were 119 adenoidectomies and 278 adenotonsillectomies performed. The average age was 3 years at the time of surgery. One hundred and ninety-six cases were performed for obstruction, and 201 were done for infection. Average time spent in the postanaesthesia care unit was 6 hours for adenotonsillectomy and 4.5 hours for adenoidectomy. There were 26 planned and 60 unplanned admissions. One (4/397) percent of the unplanned admissions were for postoperative hemorrhage; 14% (56/397) were for vomiting and dehydration. No cases were admitted for postoperative desaturations or hypotensive episodes. The readmission rate was 0%. CONCLUSIONS: Ambulatory adenotonsillectomy is a safe procedure in children less than 5 years old. However, a well-informed, reliable caretaker and support from the day surgery staff is essential in early discharge of young patients after adenotonsillectomy.

Sleep apnea syndrome associated with upper airway obstruction.

A working protocol is presented which has developed to help the clinician in the diagnosis and management of patients suffering from the sleep apnea syndrome associated with various types of upper airway obstruction.