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Tonsillektomie bei Kindern

Präoperative Evaluation von Risikofaktoren

Tonsillectomy in children

Preoperative evaluation of risk factors

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Zusammenfassung

Die Tonsillektomie stellt einen der häufigsten operativen Eingriffe im Kindesalter dar und ist mit einem relativ hohen postoperativen Risiko behaftet. Oft stellt sich die Frage, inwieweit schlafbezogene Atmungsstörungen präoperativ abgeklärt werden sollten und in welchem Umfang präoperative Gerinnungsuntersuchungen erforderlich sind. Hierzu wurde die aktuell verfügbare deutsch- und englischsprachige Fachliteratur ausgewertet. Bei Vorliegen einer schlafbezogenen Atmungsstörung ist im Kindesalter die (Adeno-)Tonsillektomie in der Mehrzahl der Fälle eine kurative Maßnahme. Bei Vorliegen bestimmter Risikofaktoren (schwere Schlafapnoe, massive Adipositas, kraniofaziale Fehlbildungen) ist jedoch auf respiratorische Komplikationen zu achten. Eine routinemäßige schlafmedizinische Diagnostik vor Tonsillektomie ist weder erforderlich noch praktikabel. Angeborene Störungen der Hämostase üben einen vergleichsweise geringen Einfluss auf das Auftreten einer postoperativen Blutung aus, und der prädiktive Wert einer Routinegerinnungsdiagnostik ist gering. Bei negativer Blutungsanamnese ist eine routinemäßige Gerinnungsdiagnostik bei Kindern nicht erforderlich.

Abstract

Tonsillectomy is one of the most frequently performed surgical procedures in children and is associated with a relatively high risk of postoperative complications. The question often arises whether paediatric obstructive sleep apnoea should be diagnosed with preoperative sleep testing and whether preoperative coagulation tests should be performed in every child undergoing tonsillectomy. In order to answer these questions, the relevant German and English literature was analysed. Adenotonsillectomy in childhood usually resolves the underlying sleep-related breathing disorder. Nevertheless, especially in children with clinical risk factors such as severe sleep apnoea, obesity or craniofacial malformation, respiratory complications should be expected in the postoperative phase. Routine sleep tests prior to tonsillectomy are neither necessary nor practical for preoperative evaluation. Inherited coagulation disorders have only a limited effect on the occurrence of postoperative bleeding and the predictive value of routine coagulation tests is limited. As long as a thorough clinical history is negative, routine coagulation tests are not helpful or necessary prior to tonsillectomy in children.

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Authors and Affiliations

  1. Schlafmedizinisches Zentrum, Universitäts-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Mannheim, 68135, Mannheim, Deutschland

    B.A. Stuck

  2. Klinik für Anästhesiologie und operative Intensivmedizin, Medizinische Fakultät, Universitätsklinikum Mannheim, Mannheim, Deutschland

    H.V. Genzwürker

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  1. B.A. Stuck
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Correspondence to B.A. Stuck.

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Stuck, B., Genzwürker , H. Tonsillektomie bei Kindern. Anaesthesist 57, 499–504 (2008). https://doi.org/10.1007/s00101-008-1337-7

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  • DOI: https://doi.org/10.1007/s00101-008-1337-7

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