Anaesthesia for elective ear, nose and throat surgery in children

This review is an update of anaesthesia for elective ear, nose and throat procedures commonly performed in the paediatric population. Increasingly these often-complex procedures are being undertaken as day cases and so preoperative assessment needs to be tailored accordingly to identify those children requiring closer postoperative monitoring. Assessment of co-morbidities, consequences of the child’s presenting pathology (e.g. obstructive sleep apnoea (OSA)), bleeding risk and the presence of any concurrent upper respiratory tract infections needs to be the focus of the preoperative visit. Day case procedures involve careful patient selection and good communication with families regarding the post-operative phase and potential complications. Adenotonsillectomy is most commonly performed to relieve the symptoms of OSA. The main anaesthetic concerns include co-morbidities (e.g. obesity), analgesia including the potential use of non-opioids like dexmedetomidine, post-operative nausea and vomiting (PONV), risk of postoperative haemorrhage, postoperative respiratory complications and postoperative disposition. Children undergoing middle ear surgery need careful consideration to prevent problems associated with bleeding, hypothermia and PONV, and staff need to be aware of any hearing deficit that the child may have. Use of lasers is common in airway surgery with children often having repeated laser procedures; associated risks include airway fire and injury to the eyes of the patient and theatre staff.