Comparison of Functional Outcomes after Powered Intracapsular Tonsillectomy with Adenoidectomy and Conventional Extracapsular Tonsillectomy with Adenoidectomy for Pediatric Obstructive Sleep Apnea

Background and Objectives This study was investigated to compare the clinical outcomes and complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) with those of conventional extracapsular tonsillectomy and adenoidectomy (ECTA) in treatment of pediatric obstructive sleep apnea (OSA).Subjects and Method Eighty-one children with adenotonsillar hyperplasia underwent tonsillectomy and adenoidectomy (46 PITA and 35 ECTA) from December 2016 to July 2017 for OSA. The choice of surgical procedure (PITA vs. ECTA) was determined by the number of episodes of acute tonsillitis. The quality of life measurement was performed using Korean Obstructive Sleep Apnea Survey (KOSA-18) score. Postoperative bleeding was assessed as number of revisit or readmission. Postoperative pain was evaluated by visual analog scale (VAS) at postoperative day 1, 3, and 7.Results PITA and ECTA significantly reduced KOSA-18 scores postoperatively (p＜0.01, p＜0.01, respectively) and were equally effective in pediatric OSA treatment. Postoperative bleeding was lower in the PITA group, but there was no statistical difference due to small number of cases. VAS score for postoperative pain was significantly lower in the PITA group at day 1, 3, and 7 (p=0.03, p＜0.01, and p＜0.01, respectively).Conclusion PITA is effective in pediatric OSA treatment with less morbidity, and less complications.

Post-Tonsillectomy Bleeding

Post-tonsillectomy bleeding is a well-described complication that can rapidly evolve into one of the most challenging clinical situations in anesthesia. Tonsillectomy and adenoidectomy is one of the most common pediatric surgical procedures. A frequent indication for this procedure is adenotonsillar hyperplasia associated with obstructive sleep apnea. These children may be very challenging to care for and may have significant respiratory and fluid management issues postoperatively. This situation requires immediate attention and action with regard to resuscitation in a hypovolemic patient in combination with the challenges of a potentially difficult airway. This chapter discusses obstructive sleep apnea and its associated increased risk of postoperative complications with regard to tonsillectomy and adenoidectomy. It also reviews risk factors for postoperative tonsillar bleeding and the considerations in treating these children.