Der Anaesthesist

, Volume 57, Issue 5, pp 499–504 | Cite as

Tonsillektomie bei Kindern

Präoperative Evaluation von Risikofaktoren
Allgemeinanästhesie

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.

Schlüsselwörter

Tonsillektomie Kinder Postoperative Blutung Schlafbezogene Atmungsstörung Gerinnungsstörung 

Tonsillectomy in children

Preoperative evaluation of risk factors

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.

Keywords

Tonsillectomy Children Postoperative bleeding Sleep-related breathing disorder Coagulation disorder 

Notes

Interessenskonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Acosta M, Edwards R, Jaffee IM et al. (2005) A practical approach to pediatric patients referred with an abnormal coagulation profile. Arch Pathol Lab Med 129: 1011–1016PubMedGoogle Scholar
  2. 2.
    Asaf T, Reuveni H, Yermiahu T et al. (2001) The need for routine pre-operative coagulation screening tests (prothrombin time PT/partial thromboplastin time PTT) for healthy children undergoing elective tonsillectomy and/or adenoidectomy. Int J Pediatr Otorhinolaryngol 61: 217–222PubMedCrossRefGoogle Scholar
  3. 3.
    Boudewyns AN, Heyning PH van de (1995) Obstructive sleep apnea syndrome in children: an overview. Acta Otorhinolaryngol Belg 49: 275–279PubMedGoogle Scholar
  4. 4.
    Brietzke SE, Gallagher D (2006) The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Otolaryngol Head Neck Surg 134: 979–984PubMedCrossRefGoogle Scholar
  5. 5.
    Close HL, Kryzer TC, Nowlin JH, Alving BM (1994) Hemostatic assessment of patients before tonsillectomy: a prospective study. Otolaryngol Head Neck Surg 111: 733–738PubMedCrossRefGoogle Scholar
  6. 6.
    Eberl W, Wendt I, Schroeder HG (2005) Präoperatives Screening auf Gerinnungsstörungen vor Adenotomie und Tonsillektomie. Klin Padiatr 217: 20–24PubMedCrossRefGoogle Scholar
  7. 7.
    Eisert S, Hovermann M, Bier H, Göbel U (2006) Präoperative Gerinnungsuntersuchungen bei Kindern vor Adenotomie (AT) und Tonsillektomie (TE): Schützen sie vor Blutungskomplikationen? Klin Padiatr 218: 334–339PubMedCrossRefGoogle Scholar
  8. 8.
    Erler T, Paditz E (2004) Obstructive sleep apnea syndrome in children: a state-of-the-art review. Treat Respir Med 3: 107–122PubMedCrossRefGoogle Scholar
  9. 9.
    Hoeve LJ, Pijpers M, Joosten KF (2003) OSAS in craniofacial syndromes: an unsolved problem. Int J Pediatr Otorhinolaryngol 67: S111–113PubMedCrossRefGoogle Scholar
  10. 10.
    Howells RC 2nd, Wax MK, Ramadan HH (1997) Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy. Otolaryngol Head Neck Surg 117: 628–632PubMedCrossRefGoogle Scholar
  11. 11.
    Koscielny J, Ziemer S, Radtke H et al. (2004) A practical concept for preoperative identification of patients with impaired primary hemostasis. Clin Appl Thromb Hemost 10: 195–204PubMedCrossRefGoogle Scholar
  12. 12.
    Kumar VV, Kumar NV, Isaacson G (2004) Superstition and post-tonsillectomy hemorrhage. Laryngoscope 114: 2031–2033PubMedCrossRefGoogle Scholar
  13. 13.
    Lillicrap D, Nair SC, Srivastava A et al. (2006) Laboratory issues in bleeding disorders. Haemophilia 12: S68–75CrossRefGoogle Scholar
  14. 14.
    Manning SC, Beste D, McBride T, Goldberg A (1987) An assessment of preoperative coagulation screening for tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 13: 237–144PubMedCrossRefGoogle Scholar
  15. 15.
    McColley SA, April MM, Carroll JL et al. (1992) Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 118: 940–943PubMedGoogle Scholar
  16. 16.
    Mitchell RB, Kelly J (2007) Outcome of adenotonsillectomy for obstructive sleep apnea in obese and normal-weight children. Otolaryngol Head Neck Surg 137: 43–48PubMedCrossRefGoogle Scholar
  17. 17.
    Mitchell RB (2007) Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope 117: 1844–1854PubMedCrossRefGoogle Scholar
  18. 18.
    Myssiorek D, Alvi A (1996) Post-tonsillectomy hemorrhage: an assessment of risk factors. Int J Pediatr Otorhinolaryngol 37: 35–43PubMedCrossRefGoogle Scholar
  19. 19.
    O’Brien LM, Sitha S, Baur LA, Waters KA (2006) Obesity increases the risk for persisting obstructive sleep apnea after treatment in children. Int J Pediatr Otorhinolaryngol 70: 1555–1560CrossRefGoogle Scholar
  20. 20.
    Rasmussen N (1987) Complications of tonsillectomy and adenoidectomy. Otolaryngol Clin North Am 20: 383–390PubMedGoogle Scholar
  21. 21.
    Raut V, Bhat N, Kinsella J et al. (2001) Bipolar scissors versus cold dissection tonsillectomy: a prospective, randomized, multi-unit study. Laryngoscope 111: 2178–2182PubMedCrossRefGoogle Scholar
  22. 22.
    Rosen GM, Muckle RP, Mahowald MW et al. (1994) Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated? Pediatrics 93: 784–788PubMedGoogle Scholar
  23. 23.
    Sanchez-Armengol A, Capote-Gil F, Cano-Gomez S et al. (1996) Polysomnographic studies in children with adenotonsillar hypertrophy and suspected obstructive sleep apnea. Pediatr Pulmonol 22: 101–105PubMedCrossRefGoogle Scholar
  24. 24.
    Sanders JC, King MA, Mitchell RB, Kelly JP(2006) Perioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome. Anesth Analg 103: 1115–1121PubMedCrossRefGoogle Scholar
  25. 25.
    Shine NP, Coates HL, Lannigan FJ, Duncan AW (2006) Adenotonsillar surgery in morbidly obese children: routine elective admission of all patients to the intensive care unit is unnecessary. Anaesth Intensive Care 34: 724–730PubMedGoogle Scholar
  26. 26.
    Solares CA, Koempel JA, Hirose K et al. (2005) Safety and efficacy of powered intracapsular tonsillectomy in children: a multi-center retrospective case series. Int J Pediatr Otorhinolaryngol 69: 21–26PubMedCrossRefGoogle Scholar
  27. 27.
    Statham MM, Elluru RG, Buncher R, Kalra M (2006) Adenotonsillectomy for obstructive sleep apnea syndrome in young children: prevalence of pulmonary complications. Arch Otolaryngol Head Neck Surg 132: 476–480PubMedCrossRefGoogle Scholar
  28. 28.
    Strauß JM, Becke K, Schmidt J (2006) Blutgerinnung vor Adenotomie und Tonsillektomie im Kindesalter – wozu? Anaesthesiol Intensivmed 47: 561–562Google Scholar
  29. 29.
    Williams R (1967) Haemorrhage following tonsillectomy and adenoidectomy. (A review of 18,184 operations). J Laryngol Otol 81: 805–808PubMedCrossRefGoogle Scholar
  30. 30.
    Windfuhr JP, Chen YS, Remmert S (2005) Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 132: 281–286PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Schlafmedizinisches Zentrum, Universitäts-HNO-KlinikMedizinische Fakultät, Universitätsklinikum MannheimMannheimDeutschland
  2. 2.Klinik für Anästhesiologie und operative IntensivmedizinMedizinische Fakultät, Universitätsklinikum MannheimMannheimDeutschland

Personalised recommendations