The nasopharyngeal prong airway: an effective post-operative adjunct after adenotonsillectomy for obstructive sleep apnoea in children.
OBJECTIVE
Obstructive sleep apnoea is a common childhood disorder. Adenotonsillar enlargement is most commonly implicated, with adenotonsillectomy representing an effective treatment in the majority of cases. Such children may develop respiratory compromise post-operatively, sometimes necessitating admission to the intensive care unit. We describe insertion of a nasopharyngeal "prong" airway and evaluate its benefits after adenotonsillectomy for obstructive sleep apnoea and milder forms of sleep-disordered breathing.


METHODS
The prong is easily fashioned from a paediatric endotracheal tube. It is inserted once surgery is complete, remaining in situ overnight. We retrospectively examine its elective use over an 18-month period in selected children considered to be at high risk of post-operative respiratory compromise. Existing practice over the preceding 18-month period is also examined, by way of comparison.


RESULTS
Forty-three children underwent adenotonsillectomy for sleep-disordered breathing/OSAS in the 18 months prior to introduction of the prong. Ten were considered "high risk" cases: post-operative intensive care beds were pre-booked for these, but none were eventually required. During the subsequent 18 months, 60 children underwent adenotonsillectomy for the same indication. Seventeen "high risk" cases received the prong post-operatively. No intensive care beds were pre-booked and all children were managed safely on the ENT ward, with minimal intervention.


CONCLUSIONS
Use of a nasopharyngeal prong significantly improves the post-operative course of selected children who are at high risk of respiratory compromise after adenotonsillectomy. This largely avoids the need for medical intervention and intensive care admission.
Tweedie
D J
DJ
Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK. dtweedie@doctors.org.uk
Skilbeck
C J
CJ
Lloyd-Thomas
A R
AR
Albert
D M
DM
D000233:Adenoidectomy / Q000009:adverse effects / Q000295:instrumentation*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007440:Intubation / Q000295:instrumentation*; D009305:Nasopharynx; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects / Q000295:instrumentation*; D016896:Treatment Outcome