Children with severe obstructive sleep apnoea, those under three years, and those with obesity, craniofacial abnormalities, neuromuscular disease or significant cardiac or respiratory comorbidity are at higher risk of respiratory complications after adenotonsillectomy. Major otolaryngology guidance recommends planned inpatient overnight monitoring for these children rather than day-case discharge.
The decision is best made at listing, with the polysomnography and comorbidities in hand, so the bed and monitoring are arranged and families know what to expect.
- Plan overnight monitored admission for children with severe OSA on polysomnography.
- Admit children under three years overnight after adenotonsillectomy.
- Include obesity, craniofacial syndromes, neuromuscular disease and cardiac disease in the risk assessment.
- Use continuous pulse oximetry overnight for high-risk children.
- Discuss the plan with the anaesthetist and family at listing, not on the day.
Why it matters
Respiratory events after adenotonsillectomy cluster in predictable children and are safer managed where they can be seen.
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