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For the perioperative management of pediatric tonsillectomy, Acetaminophen, NSAIDs, and steroids are recommended.
A recent systematic review, performed by Alfonso E. Albornoz and colleagues and published in the Canadian Journal of Anesthesia, shed light on the perioperative pain management strategies of tonsillectomy in children given the lack of specific clinical practice guidelines (CPGs) personalized to the perioperative stage. The review intended to examine current CPGs regarding perioperative management for pediatric tonsillectomy.
Online databases, such as Embase, MEDLINE, MEDLINE ePub Ahead of Print, and CINAHL were searched for applicable studies published up to August 3, 2022. Inclusion criteria encompassed CPGs providing evidence-based recommendations for tonsillectomy under general anesthesia in children, published in English. Key findings from the review revealed 5 eligible CPGs, with 2 of them rated as high quality as per the Appraisal of Guidelines for Research & Evaluation (AGREE II) and REX criteria.
However, only 1 of these CPGs was recommended for application without modifications. The majority of recommendations focused on pain management approaches. Notably, Acetaminophen appeared as the sole medicine constantly recommended across all 5 CPGs. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids were advocated for pain management in most CPGs, except the oldest one.
This insightful analysis highlighted the need for further clarification on opioid use in pediatric tonsillectomy, particularly considering the harshness of sleep apnea and the potential utilization of opioid-sparing practices like Dexmedetomidine (selective α2-adrenergic agonist), high-dose Dexamethasone (glucocorticoid medication), and Gabapentinoids (antiepileptic agents).
Canadian Journal of Anesthsia
Perioperative clinical practice recommendations for pediatric tonsillectomy: a systematic review
Alfonso E Albornoz et al.
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