European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 8, pp 2317–2324

Respiratory complications after diode-laser-assisted tonsillotomy

  • Miloš Fischer
  • Iris-Susanne Horn
  • Mirja Quante
  • Andreas Merkenschlager
  • Jörg Schnoor
  • Udo X. Kaisers
  • Andreas Dietz
  • Karsten Kluba
Miscellaneous

Abstract

Children with certain risk factors, such as comorbidities or severe obstructive sleep apnea syndrome (OSAS) are known to require extended postoperative monitoring after adenotonsillectomy. However, there are no recommendations available for diode-laser-assisted tonsillotomy. A retrospective chart review of 96 children who underwent diode-laser-assisted tonsillotomy (07/2011–06/2013) was performed. Data for general and sleep apnea history, power of the applied diode-laser (λ = 940 nm), anesthesia parameters, the presence of postoperative respiratory complications and postoperative healing were evaluated. After initially uncomplicated diode-laser-assisted tonsillotomy, an adjustment of post-anesthesia care was necessary in 16 of 96 patients due to respiratory failure. Respiratory complications were more frequent in younger children (3.1 vs. 4.0 years, p = 0.049, 95 % CI −1.7952 to −0.0048) and in children who suffered from nocturnal apneas (OR = 5.00, p < 0.01, 95 % CI 1.4780–16.9152) or who suffered from relevant comorbidities (OR = 4.84, p < 0.01, 95 % CI 1.5202–15.4091). Moreover, a diode-laser power higher than 13 W could be identified as a risk factor for the occurrence of a postoperative oropharyngeal edema (OR = 3.45, p < 0.01, 95 % CI 1.3924–8.5602). Postoperative respiratory complications should not be underestimated in children with sleep-disordered breathing (SDB). Therefore, children with SDB, children with comorbidities or children younger than 3 years should be considered “at risk” and children with confirmed moderate to severe OSAS should be referred to a PICU following diode-laser-assisted tonsillotomy. We recommend a reduced diode-laser power (<13 W) to reduce oropharyngeal edema.

Keywords

Partial tonsillectomy Laser-assisted tonsillotomy Sleep-disordered breathing Respiratory complication Oropharyngeal edema Diode-laser 

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Miloš Fischer
    • 1
  • Iris-Susanne Horn
    • 1
  • Mirja Quante
    • 2
  • Andreas Merkenschlager
    • 2
  • Jörg Schnoor
    • 3
  • Udo X. Kaisers
    • 3
  • Andreas Dietz
    • 1
  • Karsten Kluba
    • 3
  1. 1.Department of ORL-HNSUniversity Hospital LeipzigLeipzigGermany
  2. 2.Hospital for Children and Adolescents and Center for Pediatric Research (CPL)University of LeipzigLeipzigGermany
  3. 3.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital LeipzigLeipzigGermany

Personalised recommendations