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Eur J Anaesthesiol. 2013 Sep;30(9):529-36. doi: 10.1097/EJA.0b013e32835df608.

The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy: a randomised controlled trial.

Author information

1
Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Subiaco, WA 6008, Australia. britta.regli-vonungern@health.wa.gov.au

Abstract

CONTEXT:

There is ongoing debate regarding the optimal timing for tracheal extubation in children at increased risk of perioperative respiratory adverse events, particularly following adenotonsillectomy.

OBJECTIVE:

To assess the occurrence of perioperative respiratory adverse events in children undergoing elective adenotonsillectomy extubated under deep anaesthesia or when fully awake.

DESIGN:

Prospective, randomised controlled trial.

SETTING:

Tertiary paediatric hospital.

PATIENTS:

One hundred children (<16 years), with at least one risk factor for perioperative respiratory adverse events (current or recent upper respiratory tract infection in the past 2 weeks, eczema, wheezing in the past 12 months, dry nocturnal cough, wheezing on exercise, family history of asthma, eczema or hay fever as well as passive smoking).

INTERVENTION:

Deep or awake extubation.

MAIN OUTCOME MEASURE:

The occurrence of perioperative respiratory adverse events (laryngospasm, bronchospasm, persistent coughing, airway obstruction, desaturation <95%).

RESULTS:

There were no differences between the two groups with regard to age, medical and surgical parameters. The overall incidence of complications did not differ between the two groups; tracheal extubation in fully awake children was associated with a greater incidence of persistent coughing (60 vs. 35%, P = 0.028), whereas the incidence of airway obstruction relieved by simple airway manoeuvres in children extubated while deeply anaesthetised was greater (26 vs. 8%, P = 0.03). There was no difference in the incidence of oxygen desaturation lasting more than 10 s.

CONCLUSION:

There was no difference in the overall incidence of perioperative respiratory adverse events. Both extubation techniques may be used in high-risk children undergoing adenotonsillectomy provided that the child is monitored closely in the postoperative period.

TRIAL REGISTRATION:

Australian New Zealand Clinical Trials Registry: ACTRN12609000387224.

PMID:
23344124
DOI:
10.1097/EJA.0b013e32835df608
[Indexed for MEDLINE]

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