Scripties UMCG - Rijksuniversiteit Groningen
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Adenotonsillectomie volgens Sluder onder inhalatieanesthesieHogere incidentie van hypoxemie bij zittende versus liggende operatiehouding

(2018) Verbeek, A.C.M.

Background Sluders’ adenotonsillectomy is one of the most commonly performed operations during childhood in the Netherlands. The intervention can be done with or without endotracheal intubation. In 66% of Dutch hospitals it is performed non-intubated. The adenotonsillectomy is conducted with the patient sitting upright or in supine position, depending on the preference of the surgeon. Little is known about the effects of the different positions.
Aim To investigate the incidence of hypoxemia (SaO₂ < 85% ≥ 60 sec) during non-intubated adenotonsillectomy according to Sluder in sitting versus supine position. Secondary outcomes are the incidence of bradycardia and hemorrhage.
Methods A retrospective database was drawn up with data from all patients in which an Sluders’ adenotonsillectomy was performed under inhalation anesthesia in a peripheral hospital between 01-01-2012 and 01-05-2018. Patients were categorized based on their surgery position: sitting or supine. Patient data on age, sex, height, weight, oxygen saturation, heart rate, need for intubation and hemorrhage were analyzed, using surgical and anesthetic reports.
Results We analyzed the data of 723 patients, 193 in sitting and 530 in supine position. The average age was 4,5 years, the average weight was 18,7 kilograms. There were statistically significant more patients showing hypoxemia in the sitting group, respectively 13 patients (6,7%) versus 13 patients (2,5%) in the supine group. There was no statistical significant difference in bradycardia between the testing groups. No patient with hypoxemia and bradycardia occurring simultaneously existed in the entire study population. In 13 patients, of which 11 were operated lying down, an hemorrhage has occurred.
Conclusion In this retrospective study the incidence of hypoxemia appears higher when performing the adenotonsillectomy according to Sluder in sitting versus supine position.

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