Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomy.
BACKGROUND
It is still disputed whether laryngeal mask airway (LMA) is safe and convenient for adenotonsillectomy, and whether these procedures can be safely undertaken in an office-based short-stay ambulatory setting. We report the result of this practice in 1126 consecutive children < 16 years of age.


METHODS
The patients received general anaesthesia with propofol and remifentanil. For analgesic prophylaxis, they received paracetamol, fentanyl and local anaesthetic administration. NSAIDs were given to patients weighing above 15 kg. A surgical technique with elevation, scissors and electrocoagulation was used. Post-operatively, the tonsillectomies were observed in the unit for at least 1.5 h and the adenoidectomies for at least 15-20 min.


RESULTS
Conversion from LMA to an endotracheal tube was carried out in six patients (0.5%), mostly due to airway leakage during ventilation. One patient had a pulmonary atelectasis and was re-intubated. No re-operation was needed in the clinic after surgery, and all patients, except for the one with atelectasis (0.1%), were discharged home as planned. In 122 patients answering a questionnaire, after discharge, two patients (1.6%) were admitted to hospital and re-operated due to bleeding; a further six patients (4.9%) were admitted for observation. In 25% of the patients, nausea and vomiting occurred after discharge, including 21% vomiting of swallowed blood during home travel. Only 5.6% reported significant post-discharge pain.


CONCLUSIONS
With a well-trained team, adenotonsillectomy on children can be carried out safely in an office-based setting with LMA and a short post-operative stay.
Gravningsbråten
R
R
Asker ENT Clinic, Asker, Norway. roa-gra@online.no
Nicklasson
B
B
Raeder
J
J
D000233:Adenoidectomy / Q000379:methods* / Q000706:statistics & numerical data; D000293:Adolescent; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D000771:Anesthesia, Intravenous; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D007902:Length of Stay; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology; D010348:Patient Care Team; D010824:Physicians' Offices; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000209:etiology; D014068:Tonsillectomy / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome